Depressive disorder is generally known to have a significant impact on patients’ health-related quality of life. Although studies have shown the efficacy of antidepressant drugs for treating depressive disorder, the effect of these drugs on patients’ overall well-being and quality of life remains controversial. It is well known that antidepressant therapy needs a certain time to take effect. Older tricyclic antidepressants took an average of one month (in some cases up to 6 weeks) before they could begin to show significant clinical improvement. This included a better quality of sleep, appetite and less physical fatigue. Correction of mood and any associated anxiety disorder usually occurs in a second phase. There are people who claim that they have had no benefit from taking antidepressants, especially the more modern ones, serotonin uptake inhibitors (SSRIs).
Other patients say that while they feel better after years of following their treatment, they do not intend to abandon it or try to cut doses to reduce addiction. Given that antidepressants are often prescribed even in situations where there is no true diagnosis of major depression or a relatively severe reactive depressive syndrome, the data from the studies may have been falsified on the effectiveness of these drugs in the real world. Often, then, SSRIs are associated with the prescription of the evening intake of an anxiolytic, generally a benzodiazepine. Therefore, it is not really possible to assign whether the positive effect on anxiety derives from the true antidepressant or from the anxiolytic taken before going to sleep. Studies published a few years ago doubted the real long-term efficacy of antidepressant therapy, pointing to psychological components (placebo effect) and addiction similar to the use of benzodiazepines.
The results of a new study published by researchers at King Saud University report that over time, antidepressant use is not significantly associated with a better health-related quality of life than depressed people who are not taking the drugs. In the new study, the researchers used data from the American Medical Expenditures Panel Survey (MEPS) from 2005-2015, a large longitudinal study that tracks the health services used by Americans. Anyone diagnosed with depressive disorder was identified in the MEPS files. During the study duration, there were on average 17.47 million adult patients diagnosed with depression each year, with two years of follow-up. 57.6% of them received antidepressant therapy. The use of antidepressants has been associated with some improvement in the mental component of SF-12, the survey that tracks health-related quality of life.
However, when this positive change was compared with the change in the group of people who were diagnosed with depressive disorder but did not take antidepressants, no significant association of antidepressants with the physical or mental component of SF-12 was found. In other words, the change in quality of life observed among those taking antidepressants over two years was not significantly different from that seen among those not taking the drugs. The study did not separately analyze any subtype or varying severity of depression. The study does not mean that people with depression should stop using medications or that antidepressants aren’t a valuable component in treating depression. However, experts need to do more research on the long-term effects of these medications on quality of life. The authors say future studies should investigate the use of non-pharmacological.
Indeed, cognitive and behavioral interventions used in conjunction with antidepressants have not bee explored and may give completely different results. Beside, these data might furtherly urge the opportunity for more personalized therapies.
- Edited by Dr. Gianfrancesco Cormaci, PhD, specialist in Clinical Biochemistry.
Scientific references
Almohammed OA et al. PLoS One 2022; 17(4):e0265928.
alue Health Reg Issues. 2022; 30:127-133.
Dott. Gianfrancesco Cormaci
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