A new pill to swallow in treating depression

UnknownIt's January in Portland, dark outside more than half the time. The only glimpse of color comes from those Hawaiian Airlines billboards around town, advertising flights to tropical islands that feel financially out of reach.

An antidepressant sounds good right about now. Maybe a few bottles of antidepressants, carried close in a fanny pack and popped like mints until the weather and economy improve. There's a few problems with this pharmaceutical fantasy, though:

* Antidepressants don't work for most people who want them, according to a major new study.

* The risk of taking these pills often outweighs the benefit.

* Antidepressants are already the third-most-prescribed class of drug in the United States. This $10 billion industry doesn't need any more mildly bummed Oregon people as customers to turn a profit.

Drugs typically prescribed to treat depression work no better than placebos in most cases, according to a new analysis published last week in the Journal of the American Medical Association.

The one exception is severe depression: Most people who are depressed enough to feel suicidal or incapacitated, for example, will experience some relief from antidepressants. But the same isn't true for people with mild or moderate depression, who represent the bulk of the antidepressant market.

People who are merely singing the blues rather than drowning in them, it turns out, will find little or no more relief from their Paxil, Lexapro or Prozac than from a sugar pill.

(Why has previous research painted a rosier picture? First, drug companies have a history of downplaying negative clinical trials. Second, patients who participate in trials tend to be more depressed than the average bear, so they see more benefits from drugs. Third, just seeing a doctor can make people feel better, even when the actual medicine is ineffective.)

The new research calls the true power of happy pills into question. It certainly contradicts those drug ads about the instant, painless, magical and restorative nature of antidepressants.

It also has big implications for health care costs -- not to mention medical ethics.

Doctors wrote 164 million prescriptions for antidepressants in 2008, totaling $10 billion in U.S. sales, according to IMS Health. About 27 million Americans now take antidepressants, mostly for problems less acute than severe clinical depression.

In doing so, these patients expose themselves to side effects such as weight gain, agitation, insomnia, loss of sex drive and so on -- which in turn can lead to more health problems, doctor visits and prescriptions. Such patients might be better off exercising or spending time with friends instead.

Again, there's no question that antidepressants can be lifesavers. I've watched friends overcome crippling anxiety and even suicidal feelings while using antidepressants, usually in conjunction with therapy and exercise. When you're hurting and nothing else works, sometimes you've got to throw everything at the wall and see what sticks.

Yet this research does raise serious questions about our reliance on antidepressants and susceptibility to drug marketing. True, it's possible someone will invent a perfect pill that makes a jobless recovery in January feel like a day at the beach, but no one has yet.

Until then, the best strategy may be to bundle up, hold tight and wait for spring.

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