Health Trends: Alternatives to Antidepressants

The drugs' safety and efficacy are routinely questioned.

Tuesday, July 24, 2007

I’m not surprised when a patient tells me she doesn’t want to take antidepressants. They make some people gain weight, and some lose their interest in sex or find it more difficult to have an orgasm. Others just don’t want to take a drug that mucks with their brains. So my interest was piqued by a recent article in The Wall Street Journal that discussed a “backlash against antidepressants sparked by concerns about their safety, efficacy, and side effects [that] is helping drive patients to alternative methods.”

Given what I do for a living, my own bias is in the direction of therapies that have been rigorously tested for safety and effectiveness. However, for patients who can’t, won’t, or simply prefer not to go with conventional medicine, a prudent trial of an alternative therapy, like acupuncture or valerian, might be worth considering. But are these alternative approaches truly effective? That’s a tough question, and it depends on what you mean by “effective.”

For a drug to be effective it should work better than a placebo, but in most drug studies the placebo itself often has a measurable success rate—often around 20 percent.Thus, even if an alternative therapy is no more effective than a placebo, you’re still left with a one in five chance of feeling better at the end of the day. For some people, even this 20 percent chance of feeling better is worth it.

So what’s the bottom line? Being depressed is miserable, and the therapies we have, while effective, are not perfect. For me, alternative therapies are just that—alternative. I consider them a plan B.

Robert W. Lash, M.D. is an associate professor of internal medicine at the University of Michigan Medical School. His clinical interests include thyroid disease, diabetes, endocrine disorders in pregnancy, osteoporosis and metabolic bone disease, and medical education. A member of the LLuminari team of experts, a board certified internist and endocrinologist, Dr. Lash has an active clinical practice at the University ofMichigan.

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