Are Antidepressants Really No Better Than Sugar Pills?

New findings that some popular antidepressants may be ineffective have left millions of patients wondering what to do. Well, first, here's what not to do -- don't stop taking your medications on your own, and talk to your doctor about treatment options.

A team of scientists has made headlines and sparked an uproar by reporting that four antidepressants are little better than placebos (sugar pills) for all but the most severely depressed patients. The four medications studied were fluoxetine (Prozac), paroxetine (Paxil), venlafaxine (Effexor) and nefazodone (sold in some generic versions in the United States but as Serzone abroad).

The British, American and Canadian researchers examined newly released data from clinical trials reviewed by the U.S. Food and Drug Administration (FDA). "Compared with placebo, the new-generation antidepressants do not produce clinically significant improvements in depression in patients who initially have moderate or even very severe depression, but show significant effects only in the most severely depressed patients," the researchers wrote in the journal PLoS Medicine.

The lead researcher, Irving Kirsch of the University of Hull, stated: "Although patients get better when they take antidepressants, they also get better when they take a placebo, and the difference in improvement is not very great. This means that depressed people can improve without chemical treatments."

However, drug companies say the review is flawed. GlaxoSmithKline, the maker of Paxil, stated: "Contrary to what has been reported, this study has only examined a small subset of the total data available for antidepressants. With paroxetine for example, this study only considers data from 16 trials out of a total database of more than 170 trials involving at least 14,000 patients."

The American Psychiatric Association (APA) said the study showed the importance of individualizing treatment. "Medication helps some, but not all people with depression. For people with mild to moderate depression, psychotherapy can work as well as medication," said Dr. Nada Stotland, APA president-elect.

What Patients Should Know

Concerned patients should consult their doctors, especially when it relates to stopping antidepressants. "Never discontinue medication without talking to the doctor about it," the National Institutes of Mental Health (NIMH) stresses. "Although antidepressants are not habit-forming or addictive, abruptly ending an antidepressant can cause withdrawal symptoms or lead to a relapse."

Individuals vary widely in how they respond to antidepressants. The drugs take time to reach their full effects -even up to six weeks. And some people go through three or four different drugs before they find one that works for them. The drugs can be a lifesaver for some but might not the best choice for others.

Other treatment options:

Psychotherapy. Also known as talk therapy, this could be the best way of treating mild to moderate depression for many individuals, the NIMH says. A 2005 study even found that therapy worked as well as antidepressants for moderate and severely depressed people. To improve your chances of success, approach psychotherapy with an open mind, a willing spirit and a commitment to attending regularly.
Exercise. Regular physical activity is a chemical-free wonder drug. Aerobic (cardio) activities such as walking, dancing, tennis, basketball and swimming are typically most effective at relieving symptoms of depression.
Positive coping methods. Many people find it helpful to write in a journal, attend a support group in person or online, talk to a friend or enjoy a hobby.
Adequate sleep. Many depressed people experience sleep disorders. Approaches can include methods such as sticking to a regular sleep schedule, avoiding daytime naps, restricting caffeine and using earplugs or a white-noise machine.
Not abusing drugs or alcohol. Those habits increase the risk of depression and can worsen symptoms and interfere with treatments.
Nutrition. A balanced diet can lift mood and enhance overall health and coping abilities. This includes plenty of vegetables, fruits, whole grains and beans, adequate water, lean protein and "good" fats such as olive oil, nuts, seeds and fish. Make sure to cut back on other fats and processed starches and sugars too.
St. John's wort. This herb has long been a popular remedy for depression. Studies of the herb have shown conflicting results, with positive effects on mild to moderate depression, but no effects on major depression. People taking St. John's wort should be aware that it has numerous drug interactions, including with anticoagulants and birth control pills.

Depression is highly treatable. A combination of drugs, therapy, exercise and other methods may even out your mood. Let the latest controversy over antidepressants start a dialogue with your doctor about what's the best treatment for you.