Major depression struck nearly 16 million adults in the U.S. in 2014, making it one of the most common mental health disorders according to the National Institute of Mental Health. It's a serious problem, and doctors aren't shy about prescribing antidepressants for it. But that might soon change. According to new clinical guidelines issued by the American College of Physicians, non-drug alternatives appear to work just as well.
In the paper published in the Annals of Internal Medicine, the researchers concluded that evidence suggests cognitive behavioral therapy, in which patients work on changing destructive thoughts and behavior patterns with a therapist, is just as effective as commonly prescribed antidepressants in treating major depressive disorder.
St. John's wort was also determined to be just as effective as antidepressants and therapy, although the evidence the researchers evaluated about this supplement was considered to be of lower quality than the data available regarding therapy. Also to note: St. John's wort doesn't interact well with some medications, and dosage is hard to regulate because the Food and Drug Administration has not approved it as a treatment for depression.
The new research could spark more open-mindedness among patients and doctors about drug-free alternatives, says Dr. Tanveer Mir, chair of ACP's Board of Regents. "Second-generation antidepressants are often used as a first-line treatment for major depression, but I think looking at this study will change our practice patterns," says Mir.
The researchers made clear that they are not suggesting that antidepressants don't work well or that non-drug interventions are superior. But Mir calls the findings a "pleasant surprise," and notes that this is particularly good news for the many people who experience side effects taking antidepressants or for whom the drugs don't work.
Mir hopes that doctors will better educate patients about their treatment options and make sure they're not employing a one-size-fits-all approach to major depression — an oft-cited criticism of people who say antidepressants are overprescribed in the U.S. A combination of different treatments might be the best route for some people, but it takes some dedication on the part of both doctors and patients to figure that out.
And no matter what the intervention strategies, the bottom line is that success is in large part dependent on the patient's determination to get well. Although effective, therapy encompasses a great deal of mindfulness training and reflection and can be a demanding process. "To do well, regularly scheduled visits [with doctors and therapists] are something they have to stick to," Mir says. "Without that, there's no way you'll have good outcomes."