An paper published in January’s Journal of the American Medical Association has the medical community revisiting the use of antidepressants for mild to moderate depression.

“The study came out, and it was actually the compilation of six different studies,” said Dr. Jeffrey Ripperda, MD, of Murphysboro Health Center. “It showed that antidepressants are no better than sugar pills are for mild to moderate depression.”

According to the paper: The context of the study says that antidepressant medications represent the best established treatment for major depressive disorder, but there is little evidence that they have a specific pharmacological effect relative to pill placebo for patients with less severe depression.

This is not the first controversial study done involving antidepressants. Ripperda said that the controversy over the use of antidepressants has been going on for some time.
“This paper has gotten a lot of press, but it has been an ongoing issue since 1998.”
It was in 1998 that professor Irving Hirsch, then a member of the psychology department at the University of Connecticut, did a meta-analysis of 38 published studies involving antidepressants. The results showed that placebos were about 75 percent as good.
According to Wikipedia: Hirsch is best known for his Response Expectancy Theory, which is based on the idea that what people experience depends partly on what they expect to experience. According to Kirsch, this is the process that is behind the placebo effect and hypnosis. The theory is supported by research showing that both subjective and physiological responses can be altered by changing people’s expectancies.

“To me, the interesting part is that there is a strong effect,” Ripperda said of the study. “It’s not that people don’t get better with antidepressants, because they do. But some of it is the placebo effect. If you think you are going to get better, you do.”
Ripperda found the most recent study very interesting, and said that while it shows mild to moderate depression is not helped much by antidepressants that with very severe depression the drugs do have an effect.

Ripperda also said that he sees plenty of patients that suffer from depression. “Most of the estimates that I see say that about 10 percent of the adult population is on an antidepressant right now,” Ripperda said. “I see 2-3 people a day, at least.” Ripperda went on to say that one study he has seen said that only about 13 percent of people using an antidepressant need to be on the drug.

He also said that there are many antidepressant drugs available.
“Prozac is the grand daddy of them” Ripperda said. “And that is still heavily prescribed.”
And there are plenty of others, such as Zoloft, Paxil, Lexapro, Celexa, Luvox, Cymbalta, Effexor, Elavil, and Wellbutrin.

“This is a huge industry,” Ripperda said. “We’re talking about a couple of billion dollar industry. Some of these same meds are also used for general anxiety disorder.”
Ripperda said that one problem in the medical field today involving depression and prescriptions for antidepressants is that it’s just easier for the patient to take an antidepressant than to seek therapy.

“Therapy has actually been shown to work better, in most cases, than medication,” Ripperda said. “The problem with therapy is access. That can be a lot more expensive. It can be a lot easier to take a medication, and a large part of it is just time. People don’t have the time for therapy and it’s easier for them to take medications.”

Ripperda said that he does not automatically prescribe an antidepressant for a patient that has come to his office seeking one. He also wanted to advise people currently taking an antidepressant to not stop taking them, or for them to go “cold-turkey.”
“Anybody seeing this should not just stop taking their medication,” Ripperda said. “It’s possible to go through withdrawal. If they are considering stopping they should consult their physician first.”