No Magic Pill: A Prescription for Enhanced Shared Decision-Making for Depression Treatment

Abstract

For over 2 decades, there have been debates, sometimes contentious, about the efficacy and safety of antidepressants. Growing awareness of the difficulty some patients have when discontinuing these medications has intensified these debates. Recently, Cipriani and colleagues published the largest meta-analysis to date that assessed the efficacy and tolerability of antidepressants. They concluded that all were more efficacious than placebo, and they also synthesized the trial results from head-to-head studies in an effort to guide pharmacologic treatment for major depressive disorder in adults. Although the researchers acknowledged many limitations in their analysis, including the fact that effect sizes were modest at best, the media overstated the results of the study. Both the meta-analysis and the news stories reinvigorated the debates about whether or not antidepressants "work." Unfortunately, however, the key question-how can this meta-analysis help physicians in assisting their patients with a difficult decision about depression treatment options?-was lost in the controversy. In this commentary, we identify the questions and challenges that were not addressed in the current debate and offer specific suggestions for enhancing shared decision making for physicians working in primary care settings. (J Am Board Fam Med 2019;32:6-9.

Efficacy of new-generation antidepressants assessed with the Montgomery-Asberg Depression Rating Scale, the gold standard clinician rating scale: A meta-analysis of randomised placebo-controlled trials

“…The debate whether antidepressants are an effective treatment for depression is ongoing and unresolved [1][2][3][4][5]. Although meta-analyses unequivocally produce statistically significant drugplacebo differences in acute treatment trials [6][7][8], various researchers showed that these differences are so small that their practical relevance is questionable [9][10][11][12].…”

National Survey of Decision-Making for Antidepressants and Educational Level

“…10 A recent commentary offers suggestions for helping physicians in primary care settings address depression treatment options and uncertainties. 11 There is limited evidence on how involved people are with the decision to treat their depression and the factors that influence whether or not the decision aligns with the patients' values and preferences. Results from a meta-analysis of patient preferences for psychiatric disorders reported that overwhelmingly patients prefer psychological treatment compared with pharmacologic treatment.…”