Antidepressants No Better Than Placebo: JAMA Study

A study just published in JAMA Jan 5, reported that SSRI antidepressants are no better than placebo for most cases of depression. The authors reviewed 30 years of data and concluded that "the benefit of antidepressant medication compared with placebo may be minimal or nonexistent in patients with mild or moderate symptoms".

Of course, this is old news, and reminds me of the famous scene in 1942 film, Casablanca, where Captain Louis Renault declares, " I am Shocked, Shocked ... to find gambling here....Here is your winnings... Oh thank you."    

Better than Placebo for Severe Depression

I should add that the study found antidepressants work better than placebo for severe depression.  This is not surprising, since virtually any psycho-stimulant can be found useful for the most the severely depressed patient.

Is Depression Really a Medical Disease?

Medically speaking, the term "Depression" is a vague constellation of feelings and symptoms scored by a questionnaire called the Hamilton Depression Score.  

How to Score Depression as Mild, Moderate or Severe? Online Tools

There are a number of handy on-line tools for taking the Hamilton Depression Score Questionnaire.  Here is one of them:  For the short 17-item version of the Hamilton questionnaire, scores can range from 0 to 54.   Hamilton scores between 0 and 6 are normal.  Scores between 7 and 17 indicate mild depression, scores between 18 and 24 indicate moderate depression, and scores over 24 indicate severe depression.  According to the Jan 5 JAMA study, if your Hamilton score is less than 24, then placebo is just as effective as antidepressant drugs.  That means they work about the same as a sugar pill.

Here are the Hamilton Depression Score Questions (short version):
  
Mood (Are you sad, hopeless, helpless, worthless?) 

Feeling of Guilt (Do you have feelings of guilt, or self reproach?)

Do you have Suicide ideas, gestures or attempts? 

INSOMNIA (Do you have difficulty falling asleep, staying asleep?)

WORK AND ACTIVITIES (Do you have thoughts and feelings of fatigue or weakness related to activities,  or decreased or Stopped activities or working because of present illness?)  

Do you have Slowness of thought and speech; Do you have difficulty concentrating; slow movements)?

AGITATION (Do you have Fidgeting,  Playing with hands, hair, etc,  Moving about, can't sit still.  Hand wringing, nail biting, hair-pulling, biting of lips etc)?

ANXIETY (Do you have tension and irritability, Worrying,  Apprehension, Fears expressed)?

ANXIETY: SOMATIC (Do you have dry mouth, wind, indigestion, diarrhea, cramps, belching. - Cardio-vascular : palpitations, headaches. hyperventilation, sighing. Urinary frequency - Sweating)?

SOMATIC SYMPTOMS: GASTROINTESTINAL Do you have Loss of appetite, require laxatives or medication for bowels, or medication for gastro-intestinal symptoms?

SOMATIC SYMPTOMS: GENERAL - Do you have Heaviness in limbs, back or head? Backaches, headache, muscle aches. Loss of energy and fatigability?

GENITAL SYMPTOMS -Do you have loss of libido, menstrual disturbances?

HYPOCHONDRIASIS -  Do you have preoccupation with  your health.?

LOSS OF WEIGHT -Do you have weight loss from depression.?

INSIGHT - Acknowledges or denies being depressed.  ?

Overlapping Symptoms- Is it Really Depression ?

As is obvious, many of these feelings or symptoms are somewhat subjective and rather vague, so depression scoring is not an exact science and can be manipulated according to the agenda of the research or questioner. As you can see, many of these Hamilton symptoms overlap with real medical diseases.  For example patients with inflammatory bowel disease or celiac disease would score positive for the GI symptoms even though they may not be clinically "depressed".  Somatic symptoms of fatigue and muscle pain may overlap with fibromyalgia and hypothyroid symptoms.  Slowness of thought and speech could overlap with a low thyroid condition or a neurological disorder such as B12 deficiency.  Patients in chronic severe pain contemplating suicide may not necessarily indicate clinical "depression".  Obviously, these patients need pain relief rather than an SSRI antidepressant.

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