You’ve read about the ongoing controversy over the effectiveness of antidepressant medications. Luminary psychologists such as Dr. Robert DeRubeis and Dr. Irving Kirsch have made persuasive arguments supporting the idea that most, if not all, of the effectiveness of antidepressant medication appears to be due to the so-called placebo effect.
In other words, their analysis of studies has led them to conclude that when patients improve on antidepressant medication, that most of that improvement is readily chalked up to the expectations of improvement that come when people take a pill they believe will improve their symptoms.
In this week’s New York Times, Dr. Peter Kramer (clinical professor of psychiatry at Brown University and author of Listening to Prozac) presented arguments that antidepressant medications do exert effects over and above that obtained from placebos (i.e., sugar pills) alone. The nuances of these arguments are quite complex and will no doubt play out in academic journals for some time to come. Perhaps you expect me to now tell you which side is correct. Frankly, my own analysis of these arguments suggests that both camps have valid points. I suspect for many patients, antidepressant medications do little more than placebos; whereas for some, there is likely to be efficacy above and beyond that of sugar pills.
Regardless of the ultimate outcome of this debate, many people wonder whether they should take antidepressant medications if they have depression or obsessive compulsive disorder (OCD). And a large percentage of professionals recommend them to their patients. They reason that numerous studies have demonstrated similar improvements for antidepressant medications and psychotherapy for these problems. And then they make the logical conclusion that providing both psychotherapy and medication will result in even better outcomes.
However, precious little data suggests that combining psychotherapy and medication improves outcomes for most people. Granted, there is scattered evidence that the combination improves outcomes for a small percentage of patients, but it’s difficult to determine for whom that will the case and the additional bump from a combined approach is generally disappointingly small. So if you’re someone with depression or OCD, what does all of this mean?
Obviously, I can’t tell you what’s best for your problem and your case. However, you just might consider trying psychotherapy first if you’re depressed or have OCD. Psychotherapy usually works just as well as medication and even confers some protective value against relapses. Given that medications sometimes have serious side effects, consider seeing how you do without them for a while. On the other hand, if your progress is painfully slow or nonexistent, or if your distress is utterly overwhelming, by all means consider trying both approaches. You may be someone who will benefit.
Photo by Keith Ramsey, available under a Creative Commons attribution license.