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http://archpsyc.ama-assn.org/cgi/content/abstract/archgenpsychiatry.2011.2044v1
The above data is more consistent with what we know of depression, and the biological aspects of mental illness.
Frankly, if antidepressants don't work well, so be it. It's not our place to try to defend them as if they are somehow the mark to measure our profession. It's our job to treat people based on science, wherever that brings us. When the article came out in 2010 suggesting antidepressants don't work, I mentioned on the board that if that is the truth, so be it. We must practice based on the truth.
But from my own clinical experience, I haven't noticed antidepressants only working on the severely depressed as suggested before. Much more often than not, I've noticed them working across the spectrum. They aren't the greatest thing in the world, aren't the only way to treat depression, and depression should be treated on a multifactorial level, but that said, I've found patients of varying degrees of depression where an antidepressant helped.
When studies are well-done, I've noticed they usually support what I've noticed going on in real-life. CATIE, for example, has held to that, same with STAR*D. So far I've only seen 2 studies that I felt were reasonably well-done as far as I could tell in terms of design where the results didn't match what I was seeing in real life and that was STEP-BD (the study suggesting that antidepressants don't work in bipolar depression), and the one where antidepressants don't work except in severe depression.
Conclusions To our knowledge, this is the first research synthesis in this area to use complete longitudinal person-level data from a large set of published and unpublished studies. The results do not support previous findings that antidepressants show little benefit except for severe depression. The antidepressants fluoxetine and venlafaxine are efficacious for major depressive disorder in all age groups, although more so in youths and adults compared with geriatric patients. Baseline severity was not significantly related to degree of treatment advantage over placebo.
The above data is more consistent with what we know of depression, and the biological aspects of mental illness.
Frankly, if antidepressants don't work well, so be it. It's not our place to try to defend them as if they are somehow the mark to measure our profession. It's our job to treat people based on science, wherever that brings us. When the article came out in 2010 suggesting antidepressants don't work, I mentioned on the board that if that is the truth, so be it. We must practice based on the truth.
But from my own clinical experience, I haven't noticed antidepressants only working on the severely depressed as suggested before. Much more often than not, I've noticed them working across the spectrum. They aren't the greatest thing in the world, aren't the only way to treat depression, and depression should be treated on a multifactorial level, but that said, I've found patients of varying degrees of depression where an antidepressant helped.
When studies are well-done, I've noticed they usually support what I've noticed going on in real-life. CATIE, for example, has held to that, same with STAR*D. So far I've only seen 2 studies that I felt were reasonably well-done as far as I could tell in terms of design where the results didn't match what I was seeing in real life and that was STEP-BD (the study suggesting that antidepressants don't work in bipolar depression), and the one where antidepressants don't work except in severe depression.
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