Upfront

Are antidepressants the right treatment? Not necessarily, according to a study published in the Journal of the American Medical Association (Vol. 303, No. 1) in January.

The team of psychologists and psychiatrists found that while antidepressants help people with major depression, there’s little evidence that the drugs are more effective than a placebo when it comes to treating people with mild and moderate depression. “One needs to be careful about going too far with the findings,” warns co-author Robert DeRubeis, PhD, a psychology professor at the University of Pennsylvania. “It would be an overstatement to say that antidepressants should not be used for people with mild or moderate depression.”

Some patients with less severe depression may indeed benefit, he points out. And antidepressants may also help particular subgroups or improve problems, such as anxiety, not captured by depression measures.

Given those caveats, what should psychologists tell clients with mild to moderate symptoms? DeRubeis and other co-authors offer several scenarios:

  • Clients not on medication. Suggest they first try psychological and nonpharmaceutical approaches, such as psychotherapy and consideration of collateral biopsychosocial interventions, such as education about depression and self-help approaches and physical exercise. Encouraging clients to become actively involved in their own care is key, says Sona Dimidjian, PhD, an assistant psychology professor at the University of Colorado in Boulder, another coauthor of the JAMA article. That engagement may explain one of the reasons that placebos were just as powerful as antidepressants, she says.

  • Clients interested in medication. Help them weigh medication’s risks and costs against the potential benefits.

  • Clients already on medication. “I wouldn’t want to encourage psychologists to get in the business of countering whatever advice a medical doctor has given,” says DeRubeis. Instead, ask whether the medication is working and what the physician’s plan is for continued use. If the medication isn’t working, he says, help the client “have the courage” to discuss that with his or her physician.

—R.A. Clay