Do Antidepressants Work?

Q. Obviously, these findings are controversial. Many doctors who prescribe antidepressants insist that they see benefits in their patients. Are they wrong?

A. Their perception is entirely right. People do get better on antidepressants. And they get better on placebos. But doctors don’t prescribe sugar pills. They prescribe medications. And when they see patients getting better, they naturally attribute that to the drug. They can’t compare antidepressants to placebos in their practices. They have no way of knowing how much of the benefit is placebo effect and how much is a chemical effect. For that, you do research.

Q. What’s the bottom line from your studies?

A. Antidepressants at best have a small and clinically insignificant effect for mild, moderate and even severe depression. The drugs may be slightly more effective than placebo for people with very severe depression, at the far end of the scale. But even that small difference may be a placebo effect.

Q. Does it really matter whether the drugs work because of a placebo effect, as long as they help?

A. Some critics have said it’s wrong to tell people that the drugs don’t work, because that undermines their faith in treatment. I disagree. I think that does a disservice to patients because it keeps them on drugs that have many potential side effects and dependency instead of promoting safer and in some cases more effective treatments.

Q. What about patients who are currently using antidepressants?

A. If you’re taking an antidepressant, it’s working, and you’re not experiencing side effects, go on taking it. But if it’s not working, or not working well enough, or if you have side effects you don’t like, talk to your doctor about an alternative approach. Don’t stop taking antidepressants on your own, however, because there can be dangers to stopping all at once. Talk to your doctor before making any change.

Q. What are the alternatives?

A. Some forms of psychotherapy for treating depression have been clearly and convincingly shown to be as effective as drugs over the short term. One benefit of psychotherapy is that there are no unwanted side effects. And there’s another important advantage. One problem with medications is a high relapse rate. Depression comes back over time in about 90 percent of people on antidepressants. Studies show that relapses are far less common when people are treated with psychotherapy. In the longest-running study that I’m aware of, which followed people for six years, 60 percent of people given psychotherapy were still doing well.

Q. What does psychotherapy involve?

A. There are a variety of techniques to help people change the kind of thinking that leads them to become depressed. These techniques are called cognitive behavioral therapy. Studies also show that exercise can be effective for alleviating depression even in severely depressed patients.

Q. Why does psychotherapy seem to work better than drugs, long-term?

A. I can only speculate, but here’s one explanation. If you give people a drug and tell them it will treat their depression, and then they stop taking it, which many patients do, they’ve been led to believe that they’ll get depressed again. But if you give them psychotherapy, they learn something new, something that changes the way they think and behave. It’s a little like learning to ride a bike; you don’t forget it. You can’t stop using it, the way you can a medication. These therapies teach people new ways of coping, of dealing with stressful events, of thinking about themselves and the world that help inoculate them from depression. Many people get well and stay well.

Peter Jaret is a freelance writer in Petaluma, Calif.