Two recently published studies on depression are making the news, but one study has gotten more attention than the other. The first study revealed that the use of antidepressants may be effective only in the treatment of severe cases of depression. But the results of the second study are equally significant: the majority of Americans suffering from recent major depression remain un- or undertreated.

Degrees of depression

People suffering from mild to moderate symptoms of depression may get no benefit from antidepressants compared to placebos, according to the authors of one study published in the January 6 issue of the Journal of the American Medical Association. However, as the severity of depression increased, the benefits of the medications increased as well.

This is not breaking news, said Abhilash Desai M.D., a SLUCare psychiatrist who is also the director of SLU's Center for Healthy Brain Aging. "We've seen this in clinical practice, and in other studies. The more severe the depression, the more likely medications can help."

However, it does not mean that antidepressants will not be helpful for patients with more mild to moderate symptoms, he said. The chronic, mild depression known as dysthymia does tend to respond better to antidepressant therapy than placebo, according to Desai and the authors of the study. Additional research would be helpful in teasing out the findings, Desai suggests.

"Medication can be very effective," agreed Debbie Early, Ph.D., a clinical psychologist with St. Anthony's Medical Center. In determining if one is a good candidate for pharmacological intervention, "I usually take two things into consideration: One, is your mood down more often than not? And two, is your functioning impaired?" If the answer to both of these questions is no, therapy alone can be a very viable and effective option, according to Early. "There are a lot of tools therapists can give to help one feel better."

The research published in JAMA was an overview of the findings of six other studies (a meta-analysis), with one of the inclusion criteria being that medication/placebo comparison was followed over a period of at least 6 weeks. "It would be interesting to see what would happen over a longer period," said Early. "Antidepressants often don't show effects until taken for at least 4 to 6 weeks. And those with only mild to moderate depression may take longer to feel better."

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Global undertreatment

The other study, published in the Archives of General Psychiatry, indicates that although more than half of those who are depressed receive care of some sort, only about one in five receive treatment that meets the minimum of American Psychiatric Association guidelines.

"There are several factors that may be coming into play," said Early, citing the economy, time constraints and social stigma of mental illness.

The recently published data are "forcing us to revisit treatment of mild to moderate depression," which is the case in 75 percent of depression cases, said Desai. It provides an opportunity "not to focus on antidepressant therapy only. We need to revisit how much time is spent on other therapies ... bright light therapy for seasonal affective disorder for example."

Desai recommends that patients undergo a thorough assessment by a qualified professional who can assess all the factors and help determine the severity of the depression. This is critical, he said, as a feature of depression can often be that patients are not able to accurately self-assess the severity of the symptoms they are experiencing.

Desai is concerned that these news reports might cause patients to terminate or forego treatment, which can have serious consequences including a heightened risk of suicide. "I would not want a patient thinking 'I don't have severe depression, so I don't need to take this antidepressant,' or 'I should not seek out treatment'," he said.

But Desai sees an important opportunity in the accumulating literature. "I am hoping that we can use this research to help [doctors] use psychotherapy more, especially for acute depression."

Early echoes the sentiment, and concludes: "People often come in and say 'I should not be depressed...I have a job, a family'... but depression happens in all walks of life. [Depression] is not something people choose. It is nothing to be ashamed of. It could be biochemical; it could be situational stressors. Ultimately, (the question is) 'What do I do now? How do I cope and move on?'"