A paper from the British Journal of Psychiatry reviewed the evidence of efficacy and acceptability of antidepressant treatments for patients with minor depression. It showed there is unlikely to be a clinically important advantage for antidepressants over placebo in individuals with minor depression.
Of the six randomised controlled trials that met inclusion criteria, three compared paroxetine with placebo, while fluoxetine, amitriptyline and isocarboxazid were studied in one study each. In terms of failures to respond to treatment (6 studies, 234 patients treated with antidepressants and 234 with placebo) no significant difference between antidepressants and placebo was found. Similarly, in terms of acceptability, data extracted from two studies (93 patients treated with antidepressants and 93 with placebo) showed no statistically significant difference between antidepressants and placebo.
However, another study from the Journal of the American Medical Association discussed how the benefits of antidepressants may increase with the severity of an individual’s symptoms, and that the benefits are minimal or even non existent for people with mild or moderate symptoms of depression. It said for patients with very severe depression, the benefit of medications over placebo is substantial. But many antidepressants nowadays are prescribed for more than just mood changes: pain, sleep problems, and even changes in taste. Like cholesterol medications, antidepressants are sometimes handed out like another multi-vitamin.
More and more psychiatric disorders are appearing that might be called “lifestyle” diseases. What was once called shyness, sadness, restlessness, shopping too much, high sex drive, low sex drive and so on, have increasingly been seen as diseases and many more will appear in the new DSM – the Diagnostic Manual of Psychological and Psychiatric Disorders. The brain and body are far too complicated to assume that all problems relate to a simple chemical imbalance (see Lego People). Conditions and states of mind and mood need to be assessed properly over a period of time to ascertain whether medication is the next appropriate step.