Why does it matter whether anti-depressants are effective drugs or just placebos, as long as they do the job of lifting mood? Two reasons: (1) The drugs often cause side effects that can significantly affect people’s lives, and (2) there isa safe and equally effective alternative for treating mild or moderate depression. Psychotherapy works as well as -medication—each helps 50 to 60 percent of people feel better—and has one big advantage over pills: It may protect you from a repeat bout of depression.
In contrast, researchers recently found that discontinuing an antidepres--sant can make you more susceptible to a relapse of depression in the ensuing three months. “Our theory is that brain chemicals that affect mood, like serotonin and norepinephrine, are maintained in a balance,” says Paul Andrews, PhD, assistant professor in the department of psychology, neuroscience and behavior at McMaster University in Hamilton, Ontario. “Antidepressants artificially increase those chemicals, so when you stop taking them, the body’s control mechanism causes the neurotransmitters to plummet to lower-than-normal levels, and that causes a relapse of depression.”
While that theory is far from proven, it’s true that the risk of relapse is lower in those who participate in psychotherapy than in those who take drugs. “Anti-depressants are like aspirin for a headache. They only work as long as you’re on them,” says Steven D. Hollon, PhD, a professor of psychology at Vanderbilt University. “But cognitive behavior therapy seems to have enduring effects. People who do just therapy have half the relapse rate of those treated with medication alone.” The most plausible explanation: Therapy teaches you skills that help you deal more effectively with your negative thoughts and daily stresses.
Despite these findings, antidepressant use has soared while the percentage of patients opting for talk therapy has tumbled. One study found that among people being treated for a mental-health issue, 57 percent used medication only while just 11 percent used psychotherapy alone, and about a third used the two treatments together. “One reason is financial,” says Mark Olfson, MD, a professor of clinical psychiatry at the Columbia University School of Medicine. “Insurance companies have more generous coverage for antidepressants than for psychotherapy, so patients who want therapy have to pay more out of pocket.”
Concern No. 3
Most of the prescribing is being done by primary care physicians
Primary care physicians write four of every five scripts for antidepressants—which is a problem, because PCPs tend to be less familiar than psychiatrists with the approved or effective uses of antidepressants. That’s not a slam on primary care doctors. Most simply haven’t been trained in the nuanced pharmacology of the drugs, nor do they have time to keep up with the constantly changing literature. Besides, many have seen their patients improve on the medications, which may happen partly because of the placebo effect. But PCPs’ lack of knowledge can also lead to some patients’ winding up on the wrong drugs.
Some primary care doctors, for instance, prescribe SSRIs for migraines. “But many headache specialists believe they may actually worsen the condition in some patients,” says Andrew Charles, MD, director of the Headache Research and Treatment Program at UCLA’s David Geffen School of Medicine. The trouble is, that kind of information hasn’t filtered out from the community of specialists into the larger world of general practitioners.
Concern No. 4
Side effects may be more problematic than many patients and doctors believe