Antidepressants Work, and Depression Severity Does not Matter

Peter Roy-Byrne, MD

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In This Article

Abstract and Introduction

Abstract

Effects are greatest in children, but are significant for all, in a study examining patient-level data from 41 studies focusing on two antidepressants.

Introduction

Suggestions that antidepressants work only in severely depressed patients have been based largely on analyses comparing different study outcomes — i.e., fewer overall study effects were found in studies that had, on average, less-depressed patients — and on the existence of many unpublished studies that did not show antidepressant efficacy, suggesting that published studies overestimated efficacy. Only one small analysis ((JW Psychiatry Mar 2011, p. 21, and JAMA 2010; 303:47) of six already published and highly selected studies used individual patient-level data (N=718) to examine the issue of less effect in less-depressed patients.

These researchers obtained longitudinal, patient-specific data from all sponsored, published and unpublished, placebo-controlled studies on fluoxetine (20 trials; 705 youths, 2635 adults, and 960 geriatric patients) and venlafaxine (21 trials; 4882 adults). All patients had at least minimal depression severity at baseline. Rates of change through 6 weeks were significantly greater with antidepressant than with placebo overall and in each age group. Overall response and remission rates yielded number needed to treat (NNT) of 5 and 7, respectively. Response and remission rates were significantly greater for fluoxetine than placebo for youth (NNT, 4 and 3) and adults (NNT, 5 and 6) but not geriatric patients (NNT, 17 and 39). Most important, no relationship was found between how depressed a patient was and that patient's response to antidepressants.

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