Antidepressants most helpful in severe depression

January 01, 0001

Antidepressants most helpful in severe depression

Antidepressant medications are widely used to treat depression and depressive symptoms, but their efficacy versus placebo is often called into question, especially with less severe symptoms. These American authors sought too estimate the relative benefit of medication versus placebo across a wide range of initial symptom severity in patients diagnosed with depression. They used randomized placebo-controlled trials or adults using the Hamilton Depression Rating Scale (HDRS) if the original researchers provided the original patient level data (718 patients).

The researchers found that the difference between medication and placebo varied substantially as with baseline severity. Only a small effect was seen in patients with mild to moderate symptoms that was not felt to be clinically significant. The superiority of medication over placebo increased with baseline depression severity and was clinically significant for severe depression at baseline.

The authors concluded: “The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial.”

This study reminds us of the importance of characterizing the severity of depression before reflexively reaching for the script pad. However, the reliance on obtaining original data from the authors could have potentially introduced bias into the results, so they should be taken cautiously.

For the full abstract, click here.

JAMA 303:47-53, 6 January 2010. © 2010 to the Ameridan Medical Association
Antidepressant Drug Effects and Depression Severity-A Patient-Level Meta-analysis. Jay C. Fournier, Robert J. DeRubeis, Steven D. Hollon, et al.

Category: P. Psychological. Keywords: depression, severity, Hamilton depression rating scale, antidepressants, placebo, systematic review with meta-analysis
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 14 January 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.