A report casting doubt on the effectiveness of popular antidepressant meds for subjects with moderate symptoms has sparked debate in the mental health community. Some parties have cited the report as evidence of overmedication fed by the false claims of drug makers, and others blame its controversial conclusions on ineffective treatment practices, noting that a near-majority of Americans with severe and chronic depression never receive any form of treatment.

Pooling the results of several past short-term studies, researchers at the University of Pennsylvania found that the ultimate success of antidepressant medications correlated closely with the severity of depression in individual cases. The study considered only two forms of antidepressant medication: SSRI’s (selective serotonin uptake inhibitors) and older, less common tricyclic antidepressants. On the whole, subjects who’d been diagnosed with moderate or low-level depression saw no clinically significant improvements in any of the studies considered. Those with extreme, recurring and debilitating depression saw the most improvement in the 6 to 11 month periods covered by the collected data.

The most important word in the researchers’ concluding statements may be “mild”. Subjects with no prior mental health problems who sought treatment for cases of the moderate, incidental depression that’s often spurred by personal or financial problems may have failed to improve under the influence of antidepressant meds because the drugs weren’t needed. This suggests that some doctors, especially those who do not specialize in mental health concerns, are more likely to prescribe meds than to suggest alternative treatments, like cognitive behavioral therapy, that may ultimately prove more effective. 

The New York Times' Judith Warner believes that GPs prescribe most of these meds to subjects who will see no benefit because their depression is not severe enough. The more urgent concern is that those who need the meds the most very often do not get them - too many are being prescribed to the wrong people. A new NIMH study supports her conclusions, finding that 49% of Americans who’ve been diagnosed with major depression do not receive any form of treatment. Those who cite the UPenn study to question the validity of antidepressant medications may be overstating their case.

Commentators agree that the fact that subjects who’ve experienced deep, long-lasting depression see improvements on SSRI and tricyclic meds strongly suggests that they can be very effective for those whose conditions require serious treatment. The drugs simply need to be administered more efficiently.