Depression is one of the most common mental disorders in the United States. An estimated 21 million adults had at least one major depressive episode in 2020, and about two-thirds of those people received treatment, according to the National Institute of Mental Health.
But do people who are depressed and take an antidepressant have improvements in their health-related quality of life compared to those who don’t take medication? No, according to a new national study of US adults: Although people who took medication for depression had some improvements in health-related quality of life, they were not significantly greater than those reported by people with depression who did not take the drugs, according to a new analysis published April 20 in plus one.
Depression has worsened during the pandemic
symptoms of depression may include depressed mood, loss of interest or pleasure in daily activities, and symptoms including problems with sleeping, eating, energy, concentration, or self-esteem.
Before the pandemic, about 1 in 12 American adults reported depressive symptoms each year. According to research published in October 2021 in the journal Lancet Regional Health Americas, that number has now tripled; Nearly 1 in 3 US adults (32.8%) experienced elevated depressive symptoms in 2021.
Findings suggest antidepressants did little to improve health-related quality of life
To examine the impact of antidepressants For measures of quality of life in people with depression, the researchers used data from the 2005-2015 US Medical Expenditure Panel Survey (MEPS), a large longitudinal study tracking use of health care services. Health.
During the study period, an average of 17.5 million adult patients were diagnosed with depression and 57.6% received treatment with antidepressant medications. Each participant took a quality of life survey called the SF-12, a self-reported survey that was used to measure health-related quality of life at the beginning of the study period and at the end of the two-year follow-up. The mental health component of the SF-12 includes questions about energy, mood, and emotional state, and whether emotional problems have interfered with the person’s ability to perform normal activities.
Taking antidepressants was associated with some improvement in the mental component of SF-12, but when this positive change was compared to the change in the group of people who did not take antidepressants, the improvement was not statistically significant, according to the researchers. .
The authors concluded: “The real effect of antidepressant medication use does not continue to improve patients’ health-related quality of life over time,” as the change was about the same as in the group that did not take any medication.
Experts have found major flaws in the study’s design and conclusions
It would be wrong to conclude that antidepressants don’t improve quality of life for people with depression based on this study, he says. Paul Nestadt, MDassistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine in Baltimore.
To begin with, the tool used to assess quality of life was “clunky and inelegant,” he says. points vs. 0.9 points), the measured effect was too small to be statistically significant, “says Dr. Nestadt. By these standards, it would be difficult for any improvement to register statistical significance,” he says.
Although the health-related quality of life scale is useful for some studies as a way to measure certain aspects of public health, it is not an appropriate tool to access the efficacy of antidepressants, says Bradley Gaynes, MD, MPH, the division chief for global mental health at the UNC School of Medicine in Chapel Hill, North Carolina. “Health-related quality of life is a difficult thing to demonstrate in change. It would lend more weight to these findings if the authors had used a tool that measured depression itself,” he says.
In addition, the authors do not take into account those who used other alternative methods treatments for depression, like psychotherapy versus nothing at all, says Nestadt. “There are so many unmeasured things in these groups, including biases such as who can afford, have access to, or be willing to follow different treatments, that very few true conclusions can be drawn from this analysis of big but superficial data. put,” she says.
Treating depression is effective and important
These findings do not fit with what Nestadt sees in her clinic. “In my experience, treating depression is quite effective. We have many useful treatment interventions, including medication and psychotherapy, among others, and I have found that when used to treat a depressive disorder, the patient’s quality of life improves dramatically,” she says.
Dr. Gaynes also says that the authors’ findings and conclusions do not match his clinical experience. “When we can identify a clearly diagnosed depressive disorder and provide treatment at the appropriate dose, whether it’s medication, psychotherapy or another evidence-based therapy, it makes their depression less severe and they get better faster,” he says.
People who are depressed should seek professional treatment, and people with depression who are taking antidepressants should continue to take their medications as directed by their health care provider, says Gaynes.
“Depression is a treatable illness, and yet one symptom of the illness is the perception of hopelessness,” says Nestadt. That may mean that even though most studies show tremendous benefit from treatment, some people may feel like nothing will work for them, she adds.
“That’s dangerous and one of the reasons people don’t get care. The exaggerated conclusions of articles like this can contribute to that hopelessness and run counter to what we know can save lives,” she says.
