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Severely Depressed Gain Most from Antidepressants

But that's no reason to avoid meds for more moderate cases, expert says

TUESDAY, Jan. 5, 2010 (HealthDay News) -- Antidepressants seem to be most effective for the people with the most severe symptoms, new research suggests.

Individuals with mild-to-moderate symptoms may fare no better on antidepressants than on a placebo, say the authors of a new analysis published in the Jan. 6 issue of the Journal of the American Medical Association.

But the findings are not actually that surprising, said one expert, and don't necessarily mean that people with mild-to-moderate depression should not try antidepressants.

"I'm not sure this is a finding that's counter to giving medication to people with mild-to-moderate depression," said Dr. Gregory Asnis, director of the anxiety and depression program at Montefiore Medical Center in New York City.

Even the placebo group showed a response and, over time, the placebo effect tends to wear off, Asnis explained, whereas true drug responders continue to benefit, a difference that might not be evident in the time periods involved in the study.

"The bottom line is even though the benefits of a drug compared with placebo may be most demonstrated in severely ill people, one question is what happens in time," he said. "Placebo frequently fails as time goes on."

The findings follow on the heels of another study, released Jan. 4 in the Archives of General Psychiatry, which reported that one in five U.S. adults fails to get minimum guideline-recommended treatment for depression, and even fewer receive optimal care in minority populations such as Mexican Americans.

The authors of the more recent study scoured results from six previously completed large, randomized and placebo-controlled trials looking at major and minor depression.

Virtually no difference was noted between placebo and medication effects in people who scored lower on depression scales. But as depression severity increased, so did the drug benefits.

According to the study authors, most studies showing a benefit to antidepressants focus on more severely depressed individuals.

They suggested that patients and health-care providers should be aware that antidepressant therapy may not be as beneficial in people with milder forms of the condition.

Many of the study authors reported receiving funding from different pharmaceutical companies, although this study was funded by the National Institute of Mental Health.

More information

The National Institute of Mental Health has more on antidepressants.

SOURCES: Gregory Asnis, M.D., director, anxiety and depression program, Montefiore Medical Center, New York City; Jan. 6, 2010, Journal of the American Medical Association
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