The study suggests that antidepressants do not improve long-term quality of life

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Depression is the most common mental disorder in the world; it can affect anyone at any age. According to the World Health Organization, about 280 million people are affected, mostly women. Depression can lead to a variety of symptoms, showing various clinical forms that make diagnosis difficult. The origins of this disease are not yet clear: it can occur after trauma (death, separation, etc.), but it can also be related to neurobiological dysfunction. Antidepressant medications generally show good results. However, do they really and sustainably improve patients’ quality of life? According to a new study of millions of depressed adults, the answer is no.

Depression should be differentiated from a simple transient “depression” that everyone can experience in the face of everyday problems. Depression is a recurring, more intense, long-lasting disorder that can lead to suicide in the most severe cases. The patient is in a sad mood, no longer feeling any interest or pleasure in the activities he previously enjoyed, a behavior that is repeated almost every day, for at least two weeks. To this can be added a feeling of despair, loss of self-esteem or sleep disturbances. The patient has only a pessimistic view of the world and of himself.

Although the neurobiological origin of the disease is not yet well understood, there are several treatments to cure depression, regardless of its severity. Patients often benefit from psychological treatments, such as cognitive-behavioral therapy, and / or antidepressant medications (targeted to neurons of serotonin and / or norepinephrine and / or dopamine, hormones that contribute to our good mood). Despite numerous studies demonstrating the effectiveness of these drugs, their effect on the overall well-being of patients and their quality of life remains controversial. Therefore, researchers at King Saud University in Riyadh set out to further evaluate the effect of antidepressants.

No significant improvement reported by patients

As part of this assessment, the researchers conducted a comparative analysis of cohorts, using survey data. Medical Expense Panel Survey, collected between 2005 and 2016 in the United States. On average, 17.5 million adults were diagnosed with a depressive disorder each year during the period; the majority were women (67.9%), of whom a higher proportion received antidepressants (60.6% compared to 51.5% of men).

Health-related quality of life (qualified HRQOL) was measured using the SF-12 questionnaire, an abbreviated version of the Brief General Health Survey of Medical Outcomes Study. The responses of patients who had been treated with antidepressant drugs were compared with those of patients who had not received such treatments; specifically, it was about assessing the changes observed after a two-year follow-up, both in terms of physical and mental health.

The 12 items of the SF-12 allow to evaluate the CVRS from these two components. The physical component focuses on the physical functioning of the body, limitations due to physical health problems, body pain, general health and vitality (energy / fatigue). The mental component addresses social functioning, limitations due to emotional problems, and mental health (psychological distress and psychological well-being). Patients completed SF-12 at the beginning of the first year and then at the end of the second year of follow-up.

About 58% of the entire cohort was treated with antidepressants. Although its use was associated with some improvement in mental well-being, the analysis ultimately did not reveal any significant differences between the two cohorts.

Reassessment of the effectiveness of psychological approaches

The results also showed that in the United States, depressive disorder affects more women than men (67.9% compared to 32.1%, respectively), which is fully consistent with a report published in 2019 by the Organization World Health Organization, which had already reached the same conclusion. This prevalence within the female population remains poorly understood; some think it could be due to a simple gender bias (doctors tend to diagnose depression “more easily” in women) or to the fact that men are less likely to reveal their mental problems.

Keep in mind that this is not about definitively condemning the use of antidepressants, which in the short term remain a valuable help for patients. Like other retrospective observational studies using secondary databases, this study had some limitations. ” The use of retrospective data excludes the possibility of establishing a causal relationship; therefore, we cannot rule out that the use or non-use of antidepressants may affect HRQOL measures. “, the researchers point out PLOS One.

In addition, the study did not separately analyze the subtypes or the different degrees of severity of depression. But based on their findings, the researchers suggest further investigating the effectiveness of treatments and directing future studies toward non-pharmacological interventions: Regardless of the symptoms associated with depression and the extent of their impact on the quality of life of these patients and the side effects of antidepressant medications, the effectiveness and location of psychotherapy in these patients should be re-evaluated. “, they point out.

These non-pharmacological interventions, such as behavioral therapy, psychotherapy, or social support sessions, could further contribute to the overall improvement of patients’ quality of life, which is ultimately the ultimate goal of care and without the which the risk of relapse is high.

Source: O. Almohammed et al., PLOS One

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