Thanks for publishing that stuff, now people with depression are going to find it even harder to get jobs or be taken seriously as regular hardworking human beings in the work force.

Every person is unique and their brain is unique just as their face is. Of course people are going to react to medication is a unique way. As a person who works in a Mental Health Consumer* organisation (all our staff have had treatment from MH Services, as have our governing board members and our clients) I am well aware that for many people a pill or 10 each day is not the answer. Many antidepressant drugs have horrific side-effects, most of which are experienced from the outset. The drug usually does not really have a significant beneficial effect until 2 or 3 weeks down the track… So, to recap, you get your pills, take them (dosage is slowly increased) and have dry mouth, blurred vision, muscle spasms, loss of libido, heavy sedation (you know, that blurry feeling when your head feels full of sawdust) amongst a myriad of other awful side effects. You take the pills for about 3 weeks, feeling worse than before, then as they are not effective (or so it seems) you stop taking them, plunging your brain into a deficit of the vital chemicals it needs to get better as the pills had actually been stopping the loss of these magical chemicals in your brain. Stepped dosage-reduction is almost always required over a period in order to stop taking the medication as sudden withdrawal is definitely not advised due to the effect this has on the body (but the pharmacological companies insist that antidepressants are NOT addictive). The issue I have is when the pharmaceutical companies only publish ‘selected’ research which carefully demonstrates that their pill is the magical one and they do not release any research which is detrimental to their profit-line. They then find medical professionals who are in need of clocks, umbrellas, desk-pads, travel costs, research money…and con them into thinking that they do indeed have the mythical wonder drug and that it is the best one to prescribe to the masses. People with chronic on-going depression are usually left on their antidepressant medication for years and for some of us, we have to accept that we will always need pills to live a ‘normal’ life. Research has shown that there are options other than medication – Recently the New Zealand Guidelines Group developed and published a guideline for the Ministry of Health. The guideline is the Identification of Common Mental Disorders and Management of Depression in Primary Care. It is an evidence-based best practice guideline and its development was by a multidisciplinary team whose members were selected to represent healthcare professional, cultural and consumer perspectives. The parameters were set by the Ministry of Health. The research evidence we looked at was carefully appraised to ensure that we had ‘proper’ evidence-based studies which were capable of being replicated. Our key messages included: Psychological and pharmacological therapies are equally effective for treating adults with moderate depression, on the basis of current evidence; and A good outcome depends on partnership between the patient and practitioner and on provision of active treatment and support for a sufficient length of time; and Use of self-management strategies for depression should be encouraged and supported by practitioners. The full guideline and summary are available electronically from www.moh.govt.nz and www.nzgg.org.nz or a printed copy is available from Wickliffe on 04-496 2277 HP: 4597 (full) and HP: 4619 (summary)

* The term Mental Health Consumer is one the Ministry of Health devised, it is hated by many people who are branded by it – but rather apt in this situation as we do indeed ‘consume’ many medications, many unwillingly!

i think that this is a debate that is sort of a never ending spiral. physiologically speaking there exists nothing beyond ancedotal evidence that antidepressants work - or in fact how they work, if they do. there are many hypotheses about all these things, but like many things in psychiatry, no hard scientific evidence (testing in depth obviously presenting mutliple eithical issues). in terms of being diagnosed with depression, there are also many factors to consider as to the best approach for YOU to manage your condition. are there environment factors influencing your change in mood (stress, bereavement, bullying.....), are you actually a naturally morose personality, or are the symptoms fundamental and genuinely caused by a possible "imbalance". the decision made after considering these factors should make choosing a treatment pretty easy. your partner has died, you lost your job- we should be thinking counselling and support rather than pills i imagine and likewise if the issue is fundamental and there is nothing to "counsel" about medication seems a logical approach. i think that the fact that medicine is so often the first approach is probably a huge factor in the sick days taken by "depressed" patients as potentially 5 times out of 10 they are not actually being "treated" in any sort of useful way and there for not actually being "treated" and therefore are living daily with illness. depression seriously sucks. i have had it for almost 20 years and i have been treated with medication for half of that time. medicine has worked for me, but often in conjuction with additional therapies at times of additional stress and family deaths. i have gone through periods of frequent "sick days" but at the end of the day i know when i am at work i more often than not achieve significantly more than my "well" collegues- so, you know, swings and roundabouts :)

I use to suffer from anxiety, panic attacks and mild depression, You can read all you want study it all you like but NO-ONE will ever understand it unless you have it! # 3 Toby I understand your point of getting exercise ect but to get there can be so hard when you think your live is going to end next week. I went to work when I had my illness and it was pretty dam hard, Yeah sure I came home early some days but my employer was rally on my side, I am so lucky for having an amazing partner ( Love you hun) that gave me the most loving support and my family too! The best treatment is time and self believing, Its amazing what the mind can do! And for those who think it wont happen to them, The reality life is not always that kind people! Enjoy life people and your loved ones. :)

man I would have never EVER been able to figure this out for myself, thank you most-probably-very-expensive-study. I salute you Captain Obvious!

@toby #3: Do you have or know anyone who has depression? I'm afraid your comment comes across as rather clueless.

After realising I had clinical depression I spent several years working towards reducing the effects without any medication. This was fairly effective, but still left much to be desired. I still lost several days of productivity each month to it, which I found very frustrating.

These days a minimal dose of Citalopram each day just makes it _much_ easier to function on a daily basis. I don't wake up feeling like I'm covered in lead weights or spend several days a month getting nothing done because I just want to curl up in foetal position under my desk. I've still maintained all the practices I adopted to control it before.

People who look to a drug as a magic fix are going to be disappointed. If you have poor diet, exercise or bad patterns of thinking you can drug yourself in to impotence and it won't help you much. Combining an antidepressant with healthy living and thinking is, however, significantly more effective than just being healthy by itself.

If you have clinical depression, don't avoid taking medication that could help you. The idea of taking something that changes the way you think can be scary, and they do have side-effects, but believe me - if used properly they're worthwhile. Just be prepared to try a couple of different things and make the other changes to your life you need to get the full benefits.

Wow, who woulda thought that sick people take more sick days?

"Even when depressed patients are treated with antidepressants, there are substantial productivity losses" -- that is because antidepressants DO NOT WORK. They are a huge have by the pharmeceutical industry. Feeling blue? Get outside, get some exercise, socialise! SIMPLE. As Richard Ashcrost said, "the drugs don't work, they just make you worse"

right on cheeseslug. it's not rocket science. how much money did that study cost?

Wow, who would have thought. *Bangs head against wall.