A recent study showing that antidepressants have only a slight edge over placebos in treating depression is not surprising, researchers and doctors said.
The study, published Jan. 17 in the New England Journal of Medicine, reported that previous studies have distorted the impact of antidepressants because manufacturers failed to publish results from nearly one-third of their drug trials.
Mark Reinecke, a professor at the Feinberg School of Medicine and director of the Division of Psychology, described the paper as “well-done,” but ultimately expected. Reinecke has conducted research on the effectiveness of psychotherapy for treating depression in children and adolescents.
“When you look at published and unpublished data we see a reduction in the effect size, that is, the antidepressant meds appear to be less effective,” he said. “This shouldn’t come as a surprise; there’s a tendency of journals to accept papers with significant outcomes, so here what we’re seeing is a paper that doesn’t have significant outcomes.”
About 15 percent of college students reported they had been diagnosed with depression out of nearly 50,000 students at 74 campuses nationwide.
Current medications treat only 45 percent of patients because depression is about 50 percent genetic, said Eva Redei, Feinberg professor and researcher for the Asher Center for the Study and Treatment of Depressive Disorders.
In reality, antidepressants treat the root causes of depression only slightly better than placebos. Medication does not treat the “core of the illness,” Redei said.
Studies like this one often do not get published because they do not highlight positive findings, Reinecke said. This is referred to as the “wastebasket” or “file cabinet” effect. Pharmaceutical companies often fund medical research studies that cherry-pick data to supports their medication’s effectiveness, Reinecke said.
“There are two reasons why papers don’t get published – the first is that they have negative findings and may be uninteresting, and the other is that they may be poorly designed or executed,” he said. “This article is certainly a slap of cold water (since) it really brought this issue of file cabinet studies to the fore.”
But Dr. Joseph Mawhinney, president-elect of the California Psychiatric Association, said that he did not think the research of this particular study was very extensive.
“We’ve known for years that the adequacy of these studies aren’t really answering the question about whether the meds are effective or not,” Mawhinney said.
Mawhinney said that although antidepressants do not affect all aspects of the brain, they can still help certain forms of depression.
“What we’ve come to understand is that depression is much more complex than being just a single brain chemical,” he said. “It has been found that meds have a significant role to play, specifically for some patients who may have different forms of depression.”
Both Reinecke and Redei said that there have been no new medications in the past 20 years. The last really new antidepressant to come out was Prozac, Redei said.
“I know it sounds very disappointing, but there’s a huge gap between what doctors and scientists are able to do and want to do,” Redei said. “This is an area that is much more neglected than any other area of health or disease. .
