Crisis of confidence: antidepressant risk versus benefit

Andrew A. Nierenberg, MD, assembled a group of experts to discuss recent research and lay media reports about the safety and efficacy of antidepressants for treating mild-to-moderate depression, including recent controversy surrounding antidepressant-related suicidality. The panel agreed that the data regarding the efficacy of antidepressants are complex, making it easy to misinterpret meta-analysis results. Additionally, the issue of suicidality is quite complicated, but the risk is not great enough to abandon the use of antidepressants, although patients should be monitored carefully. The panel discussed that patients who have mild or moderate depression may benefit from receiving evidence-based psychotherapy first, instead of antidepressants. The panel stressed that additional research and novel treatments are needed to improve outcomes for patients with depression. However, measurement-based pharmacotherapy is an effective tool for helping many patients with depression achieve remission and recovery. Clear communication with the public, the media, and nonpsychiatric clinicians about the safety and efficacy of antidepressants will encourage those who need treatment to seek it.