Anti-depressant Medication or Psychological Treatment?
As you may have read in our earlier blog, feeling unusually low in mood or depressed is common following critical illness or injury.
We often meet patients who are feeling uncharacteristically low or depressed, particularly following a hospital admission. Given the difficulty patients often encounter in accessing high quality psychological treatments, they may consider trialling anti-depressant medication as an alternative. However, this may not be recommended. For mild-moderate depression psychological treatments are advised (NICE, 2009). National Guidelines (which provide treatment recommendations in the UK) recommend that anti-depressant medication is only prescribed for patients experiencing moderate-severe depression, alongside a psychological treatment.
Furthermore, evidence suggests that anti-depressant medication may not be as effective as first thought. A recent article in the British Medical Journal (BMJ) has been published by Jakobsen et al. (2020), comparing the effectiveness of anti-depressant medication to placebo. A placebo effect occurs when an improvement is produced by a placebo treatment, which cannot be attributed to the placebo itself and therefore must be due to the patient’s belief in that treatment.
In this review paper, Professor Kirsch and colleagues found that anti-depressant medication had a statistically significant benefit when compared with placebo, but not a clinically meaningful benefit. This means that while statistical software was able to detect a benefit, it was such a small effect that on average the benefit was not experienced by patients as noticeable or meaningful.
Furthermore, anti-depressants were found to increase some unwanted side effects. These findings build on other important papers reporting similar results, for example Cipriani et al (2018).
If the average effects of anti-depressant medication is found to be generally small, this inevitably means that some patients at one end of the scale may benefit significantly while a comparable proportion of patients at the other end of the scale may incur unwanted side effects. While anti-depressant medications have an important role in the treatment plans for some people, is clear from these analyses and National Guidelines is that patients who are experiencing mild-moderate low mood should primarily consider accessing a psychological therapy, rather than anti-depressant medication. At Rethink Health we specialise in providing brief, evidence based psychological treatments for adults experiencing depression and other psychological difficulties.
1. NICE cg91 (2009). Depression in adults with a chronic physical health problem: recognition and management
2. Jakobsen, J. C., Gluud, C., & Kirsch, I. (2020). Should antidepressants be used for major depressive disorder? BMJ Evidence Based Medicine, 25 (4)
3. Cipriani, A., Furukawa, T. A., Salanti, G., et al. (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. The Lancet 391:1357–66
