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Depression is the most common mental disorder in the world; it can affect anyone at any age. According to the World Health Organization, nearly 280 million people are affected, the majority of them women. Depression can lead to several symptoms, thus displaying various clinical forms that complicate the diagnosis. The origins of this disease are still unclear: it can occur after trauma (death, separation, etc.), but it can also be linked to neurobiological dysfunction. Antidepressant medications generally show good results. However, do they really and sustainably improve the quality of life of patients? According to a new study of millions of depressed adults, the answer is no.
Depression is to be differentiated from a simple transient “depression”, which everyone can experience in the face of everyday problems. Depression is a recurrent disorder, more intense and long-lasting, which can lead to suicide in the most serious cases. The patient is in a sad mood, no longer feeling any interest or pleasure in activities he once enjoyed—a behavior that repeats itself almost every day, for at least two weeks. To this can be added a feeling of despair, a loss of self-esteem or sleep disturbances. The patient has only a pessimistic view of the world and of himself.
Although the neurobiological origin of the disease is still not well understood, there are several treatments to cure depression, regardless of its severity. Patients usually benefit from psychological treatments, such as cognitive-behavioral therapy, and/or antidepressant medications (targeting serotonin and/or norepinephrine and/or dopamine neurons, hormones that contribute to our good mood). Despite numerous studies demonstrating the effectiveness of these drugs, their effect on the general well-being of patients and their quality of life remains controversial. Researchers at King Saud University in Riyadh therefore set out to further assess the effect of antidepressants.
No significant improvement reported by patients
As part of this evaluation, the researchers carried out a comparative cohort analysis, using data from the survey Medical Expenditures Panel Survey, collected between 2005 and 2016 in the United States. On average, 17.5 million adults were diagnosed with a depressive disorder each year during the period; most were women (67.9%), of whom a greater proportion were receiving antidepressants (60.6% versus 51.5% of men).
Health-related quality of life (rated HRQOL) was measured using the SF-12 questionnaire — an abbreviated version of the Medical Outcomes Study Short-Form General Health Survey. The responses of patients who had been treated with antidepressant drugs were compared with those of patients who had not received these treatments; concretely, it was a question of evaluating the changes observed after a two-year follow-up, both in terms of physical and mental health.
The 12 items of the SF-12 make it possible to assess HRQoL based on these two components. The physical component focuses on the physical functioning of the body, limitations due to physical health problems, bodily pain, general health and vitality (energy/fatigue). The mental component addresses social functioning, limitations due to emotional problems, and mental health (psychological distress and psychological well-being). Patients completed the SF-12 at the beginning of the first year, then at the end of the second year of follow-up.
About 58% of the entire cohort was treated with antidepressants. Although their use was associated with some improvement in mental well-being, the analysis ultimately revealed no significant difference between the two cohorts.
Reassessing the effectiveness of psychological approaches
The results also showed that in the United States, depressive disorder affects women more than men (67.9% versus 32.1%, respectively) — which is entirely consistent with a report published in 2019. by the World Health Organization, which had already come to the same conclusion. This prevalence within the female population remains poorly understood; some think it could be due to a simple gender bias (doctors tend to diagnose depression “more easily” in women) or to the fact that men are less likely to disclose their mental problems.
Note that there is no question here of definitively condemning the use of antidepressants, which in the short term remain a valuable aid for patients. Like other retrospective observational studies using secondary databases, this study had some limitations. ” The use of retrospective data excludes the possibility of establishing a causal relationship; thus, we cannot exclude that the use, or non-use, of antidepressants may affect HRQoL measurements “, underline the researchers in PLOS One.
In addition, the study did not analyze separately the subtypes or the different degrees of severity of depression. But based on their findings, the researchers suggest further investigating the effectiveness of treatments and directing future studies into non-pharmacological interventions: Regardless of the symptoms associated with depression and the extent of their impact on the quality of life of these patients and the side effects of antidepressant medications, the effectiveness and placement of psychotherapy in these patients should be reassessed. “, they note.
These non-pharmacological interventions, such as behavioral therapy, psychotherapy, or social support sessions, could contribute more to the overall improvement in patients’ quality of life, which is ultimately the ultimate goal of care and without which the risk of relapse is high.