If your antidepressant drugs are no longer effective in treating your mild depression, you are part of the growing anecdotal evidence questioning the efficacy of mood-stabilizing drugs. On average, 40 percent of those taking depression medication discontinue treatment. Side effects have been one cause of non-adherence, particularly with the older Tricyclic Antidepressants (TCAs), but less so with the selective serotonin reuptake inhibitors (SSRIs) that now comprise 50 percent of antidepressants prescribed. The loss of effect of depression medication is a more common cause of non-adherence in all forms of antidepressant drug treatment.
The Placebo Effect
Now a growing number of studies are mounting a clinical counterattack against antidepressant drugs by showing that they are ineffective in treating less severe forms of depression. Upsetting conventional wisdom, recent studies—a 2008 UK study on Initial Severity and Antidepressant Benefits in PLoS Medicine and, more recently, a 2010 US study on Antidepressant Drugs Effects and Depression Severity in the Journal of the American Medical Association—show no difference between a placebo and medication effect in sub-threshold and mild depression, which comprises three-quarters of those treated for depression.
These studies not only offer an explanation for the lack of effect of depression medication but also are having a large influence on options for replacing ineffective medication. Notably, there is a movement toward psychological and psychosocial over pharmacological treatments for milder forms of depression.
Psychological and Psychosocial Treatment
Health bodies, citing limited evidence, acknowledge that studies have failed to draw definitive conclusions on the effectiveness of medication management. Thus, no new recommendations have been made. Although they have recognized that medication management is more effective as part of a more complex intervention plan. In contrast, there is strong evidential support for the success of psychological and psychosocial interventions in the treatment of depression.
Confronting a lack of effect in depression medication should not necessarily result in non-adherence. Keep in mind that identifying the severity of depression is difficult. Depression treatment has proven to be reversible after nine months of treatment. Depending on the type and duration of treatment, your doctor may suggest increasing the dosage, switching to a new drug, or augmenting your current drug treatment.
Whether or not you stay on the antidepressants, the evidence strongly supports an intervention that includes psychological support, which may involve counsellng, cognitive behavioral therapy or psychodynamic therapy.