Antidepressant use is not associated with significant improvement in health-related quality of life (HRQoL) in patients with depression, new research suggests.

Researchers who conducted the study admit this finding was unexpected, and outside experts say no firm conclusions can be drawn from the research.

"Of course we were surprised by the results," first author Omar Almohammed, PharmD, PhD, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia, told Medscape Medical News.

"We were expecting to see some positive impact with the use of antidepressant medications on the HRQoL measures when we compared these patients to patients that did not use antidepressant medications," Almohammed said.

The study was published online April 20 in PLOS ONE.

Controversial Impact on Quality of Life
Depression is known to harm HRQoL. Despite evidence that antidepressants improve depressed mood, their effect on patients' overall well-being and HRQoL remains controversial.

The researchers examined the effect of antidepressants on HRQoL in adults with depression using 11 years of data from the US Medical Expenditures Panel Survey (MEPS), a large longitudinal survey that tracks health service use in the US. HRQoL was measured using the 12-item Short Form Health Survey (SF-12).

On average, about 17.5 million adults were diagnosed with depression each year during the study period (2005-2016). More than half (57.6%) of these patients were treated with antidepressants.

Patients with depression had an average age of 48.3 years. Women made up more than two thirds of the total sample (68%), and more women than men received antidepressants (61% vs 52%).

Compared with no antidepressant use, antidepressant use was associated with some improvement on the mental, but not physical, component of the SF-12, the researchers report.

However, difference-in-differences (D-I-D) univariate analysis showed no significant difference between adults using and not using antidepressants in the SF-12 physical (–0.35 vs –0.34; P = .9595) or mental component (1.28 vs 1.13; P = .6405).

"The multivariate D-I-D analyses ensured the robustness of these results," the researchers note.

The change in HRQoL observed in patients using antidepressants was not significantly different from that seen among peers not using these drugs, the researchers report.

"We are not saying that antidepressant medications are not helpful at all; HRQoL is only one of many measures intended to assess health outcomes," Almohammed told Medscape Medical News.

"Based on our research design and data, we can only say that patients who used antidepressant medications did not experience better change in terms of HRQoL compared to patients who did not use antidepressant medications," he said.
"These patients may have had some improvement on other clinical outcome measures, but that clinical improvement did not have a significant positive impact on HRQoL," he noted.

"We still recommend that patients continue using their antidepressant medications, but they may want to ask their doctors to provide them with other nonpharmacologic interventions as this may have additional impact on their HRQoL," Almohammed said.

Further research is needed to address a "gap in knowledge" about the impact of nondrug interventions — alone or in combination with antidepressant medications — on patients' HRQoL, Almohammed added.

Experts Weigh In
Several experts weighed in on the study in a statement from the British nonprofit Science Media Center.

Gemma Lewis, PhD, with University College London (UCL) in London, England, noted, "clinical trials with experimental designs have found that antidepressants improve mental health-related quality of life."

"In this study, the people who received antidepressants had worse quality of life, and are likely to have been more severely depressed, than those who did not. This type of bias is difficult to eliminate in a naturalistic study like this, which does not involve an experimental design," Lewis commented.

Eduard Vieta, PhD, with University of Barcelona, Spain, noted the "inability to control for severity of depression between the two different groups is a crucial flaw and therefore there is little we can learn from this data."

Echoing Vieta, David Curtis, MBBS, MD, PhD, with UCL Genetics Institute, said, "One might well assume that the people who were taking antidepressants had been more severely depressed than those who were not."

"From this point of view, one could argue that it seems that the antidepressants were effective and that with their use people who had presented with more severe depression did not have markedly reduced quality of life," Curtis said.

"However the reality is that this kind of observational study tells us nothing about causation. For that, clinical trials are required and numerous such trials have demonstrated that, on average, antidepressants are effective in terms of treating depressive illness and in improving the quality of life of patients with significant depression," he added.

Michael Sharpe, MD, with University of Oxford, said the study highlights the importance of measuring the long-term outcomes of treatments for depression. "However, this study has no clear implication for the care of patients with depression and certainly should not discourage patients who may benefit from taking these drugs."

Livia de Picker, MD, PhD, with University of Antwerp, Belgium, said, "What these data do point towards is the persistent treatment gap for depression in the US, with only 57.6% of patients with major depressive disorder receiving treatment with antidepressants over a 2-year follow-up."


LINK: https://www.medscape.com/viewarticle/972482#vp_2

I don't see how 'quality of life' can be used as any measure at all. Surely it is a purely subjective feeling that cannot be accurately calculated by any scientific method?

What I consider a satisfactory 'quality of life' would doubtless be completely different to another person of dissimilar age, income, upbringing, and social grouping.

Quality of life for me would include never taking drugs for my mood or depression.

Hard to have much quality of life when you walk around whacked out all the time and yes, I'm talking about women I've seen who take this stuff.

quote:

Originally posted by Pyker:
I don't see how 'quality of life' can be used as any measure at all. Surely it is a purely subjective feeling that cannot be accurately calculated by any scientific method?

Many things are measured that way. Consider pain, which is completely subjective.

quote:

Originally posted by Gustofer:

quote:

Originally posted by Pyker:
I don't see how 'quality of life' can be used as any measure at all. Surely it is a purely subjective feeling that cannot be accurately calculated by any scientific method?

Many things are measured that way. Consider pain, which is completely subjective.

It is. Which is why the old 'how much pain on a scale of 1-10 are you having?' is worthless other than a means to check a box on a form since everyone's pain tolerance varies widely. A better question might be: 'does it hurt a lot or a little?'.

quote:

Originally posted by Pyker:
It is. Which is why the old 'how much pain on a scale of 1-10 are you having?' is worthless other than a means to check a box on a form since everyone's pain tolerance varies widely. A better question might be: 'does it hurt a lot or a little?'.

There is absolutely no difference between asking about pain on a scale of 1-10 and asking if it hurts a lot or a little.

They're both subjective and add up to exactly the same thing.

I like pie. Eating pie makes me happy. Eating pie improves my quality of life. I think everyone should eat pie and be happy. More pie, less medication.

I wish you were my doctor.

quote:

Originally posted by Flash-LB:

quote:

Originally posted by Pyker:
It is. Which is why the old 'how much pain on a scale of 1-10 are you having?' is worthless other than a means to check a box on a form since everyone's pain tolerance varies widely. A better question might be: 'does it hurt a lot or a little?'.

There is absolutely no difference between asking about pain on a scale of 1-10 and asking if it hurts a lot or a little.

They're both subjective and add up to exactly the same thing.

You are correct. By that token, why bother to even ask? There is no way to gauge what the reply actually means.

Anyway, enough derailing of the OP's thread for me.

Maybe they should have stated it more as if it is an improvement in your life.

I can't imagine why anyone would take that stuff if it didn't somehow improve their life.

I have a genetic nicotine deficiency

That's not all. I have read your posts.LOL

quote:

Originally posted by ZSMICHAEL:
That's not all. I have read your posts.LOL

Badoompa.

I bet a lot of pharmaceutical industry folks would agree that it's improved their quality of life.
I'm half joking, but half not joking about that.

I have known quite few Pharma reps over the years. They are well schooled in the drugs they promote and have an answer to every question. They are rewarded when the prescriptions increase in their area. The amount physicians receive from Pharma is in a public data base. The women are generally quite attractive and bring cookies. People think that since the government has cracked down on quesionable practices that they are no longer effective. Quite the contrary.

Drugs, while not useless, need to be a very last resort. One of the side effects of some antidepressants is thoughts of suicide. Isn't that what you're trying to get away from? Another is muscle twitching and jerking. But not to worry, they've got a drug for that now … which has its own side effects. It's a vicious circle you really don't want to get into.

I would agree that there's a tendency to overdose. But I also believe medication, when properly used, has its place.

If a person has a chemical imbalance in their head without a stimulus causing it, then it certainly is called for. Even with an identified stimulus, I can see using it on a temporary basis.

If I have a broken bone and the fix is fixing the broken bone, I would still want some pain medication while it's being fixed or is healing.

quote:

Originally posted by ZSMICHAEL:
I have known quite few Pharma reps over the years. They are well schooled in the drugs they promote and have an answer to every question. They are rewarded when the prescriptions increase in their area. The amount physicians receive from Pharma is in a public data base. The women are generally quite attractive and bring cookies. People think that since the government has cracked down on quesionable practices that they are no longer effective. Quite the contrary.

My career has been in medical device / pharmaceutical companies in S&P 500 companies. Whenever I was around national sales meetings, you'd think it was a convention of high school prom queens and kings.

quote:

Originally posted by egregore:
Another is muscle twitching and jerking. But not to worry, they've got a drug for that now … which has its own side effects.

Are you talking about tardive dyskinesia? Because that’s a symptom of long-term use of antipsychotics, not the relatively benign SSRI antidepressants that are commonly prescribed for depression.

“Antipsychotic” is kind of a misnomer and that class of drugs has a number of other important uses (including, sometimes, extreme depression when a number of other treatments have failed), but they have a much higher risk profile and are not usually casually thrown at people the way SSRIs are.

I heard there are SSRIS that DO cause TD, but I don't know which ones. But when I used to work at a state mental hospital, I saw TD first hand, but those cases were not caused by SSRIs. Those patients were on very heavy doses of very old fashioned antipsychotics. The damage from those drugs was sad. Made you wonder what was worse, the disease or the meds. I don't know how far that medical field has advanced since then, I'd guess quite a bit. However the more you read about medical science, the more you understand how much doctors still don't know about lots of important stuff. It's more than you'd think, even a little scary for very common but serious ailments you'd think physicians locked down a long time ago. Well they haven't. I just watched too much star trek in the medical bay.