Take it, don't take it…
Antidepressants have not improved the quality of life of Americans
Slava Gomenyuk, N+1
An analysis of the medical histories of 17.5 million Americans with depression, of which more than half took antidepressants, showed that these drugs do not significantly affect the quality of life. As reported in the journal PLOS One (Almohammed et al., Antidepressants and health-related quality of life (HRQoL) for patients with depression: Analysis of the medical expenditure panel survey from the United States), this indicator turned out to be approximately the same for both people taking medications and people without them.
Depression can negatively affect the quality of life associated with health — an assessment by the person himself of how much the disease affects his well-being. With depression, this indicator may suffer due to unhealthy behavior: decreased physical activity, overeating, smoking and drug withdrawal.
Various studies of the effectiveness of antidepressants have shown mixed results. Some of them came to the conclusion that most of the relief of symptoms (about 80 percent) was caused by the placebo effect, further meta-analyses confirmed this. Moreover, other studies have shown that psychotherapy has comparable effectiveness compared to antidepressants.
The bulk of such studies often take place on a sample of Americans, since from 13 to 16 percent (from 30 to 40 million) of U.S. adults take antidepressants, which allows for a large heterogeneous sample. Despite the clinical data that demonstrate the effectiveness of these drugs in depressive disorder, their effect on the general well-being and quality of life of patients remains controversial.
A group of scientists led by Omar Almohammed from King Saud University decided to test how taking antidepressants affects the quality of life associated with health. This indicator was evaluated on two points: the mental component and the physical component of the quality of life. The first component focuses on social functioning, limitations due to emotional problems and mental health. The second is on physical well—being, vitality and limitations due to body health problems, pain. To assess these indicators, a scale was used, where eight components of the quality of life were evaluated according to 12 parameters.
To do this, they analyzed the data of patients with depression for the period from 2005 to 2016. On average, there were 17.47 million adult patients annually who were followed for at least two years. The average age of the included adult patients with depression was 48.3 years. About 57.6 percent of patients were treated with antidepressants.
Patients treated with antidepressants were slightly older than patients who did not (49.2 vs. 47.1 years, p<0.0001). Women made up more than two-thirds of the entire sample (67.9%), of which 60.6% received antidepressants, while only slightly more than half of men (51.5%) received drugs.
Married patients made up the largest proportion of the study sample (47.6 percent), followed by patients who had never been married (23.3 percent); the latter received antidepressants less often compared to others. The majority of patients (62.9 percent) were from middle- and high-income families.
With a simple comparison of the data, the mental component of the quality of life improved in patients taking antidepressants, which did not happen in patients without treatment. The physical component remained unchanged in both groups.
However, univariate analysis showed that both components remained unchanged in both groups (p=0.9595 for the physical component and p=0.5284 for the mental component). To make an adjustment for demographic and socio-economic variables, scientists conducted a multidimensional differential statistical analysis. It included adjustments for age, gender, race, ethnicity, marital status, poverty level and insurance.
This analysis confirmed the results of a general univariate analysis for data from 2005 to 2015, that is, taking into account all variables, taking antidepressants did not improve the physical and mental component compared to patients who did not take antidepressants (p=0.6405 for the physical component and p=0.3191 for the mental component). Thus, the use of antidepressants does not improve the health-related quality of life of patients with depression over time, since the change in this indicator is comparable to patients who did not take antidepressants.
However, it is not worth spreading such results to all people who take antidepressants. The sample is limited exclusively to Americans, and there is evidence that up to 72 percent of prescriptions for antidepressants in America are prescribed unreasonably, even without a psychiatric diagnosis. This systemic health problem can significantly affect the reliability of studies related to antidepressants conducted on Americans.
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