Antidepressant use is on the increase. According to a report released by the National Center for Health Statistics, the rate of antidepressant use in this country among teens and adults increased by almost 400% between 1980 and 2020. In fact, about 11 percent of Americans over the age of 12 take antidepressants.
The Organisation for Economic Co-operation and Development details two reasons the rate of antidepressant use may be on the rise. First, The OECD reports antidepressants are now prescribed not only for severe depression, but also for other conditions like anxiety disorders and social phobias as well. And second, antidepressants are now prescribed for long periods. Among Americans, 60 percent of those using antidepressants have been on a treatment program for multiple years and 14 percent have taken them for 10 years or longer.
However, expert opinion on the effectiveness of antidepressants differs.
What is published about anti-depressants is biased in the sense that positive results tend to be published more than negative results. In the FDA database where the pharmaceutical industry has to report all of its studies and results (whether positive or negative), including unpublished studies, there are many negative studies which are not published because there’s no economic incentive to do so. When you include all studies, about half of antidepressant studies are positive and about half the studies are negative. Antidepressants work about half the time according to large phase 3 trials.
It’s not just important to assess whether or not antidepressants are better than placebo, but how much better than placebo they are. For that answer, the effect size is a way of assessing effectiveness. An effect size greater than 0.5 is considered clinically meaningful. If it is lower than 0.5, the medication may be better than placebo, but probably does not have a significant clinical impact on patients. According to Turner’s analysis in a 2008 New England Journal of Medicine article (Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis – PubMed (nih.gov), the overall effect size of various antidepressants averaged 0.3, which indicates that they are only minimally effective.
A 2018 Lancet meta-analysis (Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis (thelancet.com) which looked at 522 randomized clinical trials, assessing 21 antidepressants and over 100,000 patients, received a lot of attention. The article concluded that antidepressants work for major depression. However, a close analysis looking at the absolute effect size of each of the drugs compared to placebo, shows a relatively small benefit of antidepressants. This and other studies show antidepressant effectiveness is lower than commonly thought.
Consider Transcranial Magnetic Stimulation
Given that antidepressants are only minimally effective in many people, it is important to consider other treatment options that patients can use instead of or in addition to antidepressants to enhance clinical outcomes. Transcranial magnetic stimulation (TMS) is a targeted form of brain stimulation therapy most commonly used to treat depression. The treatment involves the use of a magnet to stimulate a specific area of the brain that is underactive in patients with depression. TMS is typically used when other treatment options, like antidepressants, haven’t been adequately effective.
If you think you are a good candidate for TMS, contact Mid City TMS today. At Mid City TMS, we work hard to provide you with quality treatment to bring you peace of mind and help you manage your depression. Contact us today for your TMS consultation.