Decades-old treatment for depression has never been proven to work

The standard treatment for depression has been thrown into doubt after it was discovered the approach is based on bad science.

Doctors routinely change the dose or the SSRI (selective serotonin reuptake inhibitor) in a ‘step’ process as they seek out the most effective treatment.

With around 75 percent of patients getting little or no relief from the first drug, it’s a common practice—and it’s based on a series of pivotal studies, known as STAR*D, which has influenced depression treatment in the UK and the US for more than a decade.

But an analysis of the STAR*D study design has discovered that the researchers never compared the various approaches against placebo, and so they never knew if it was doing any good at all.

The researchers from Corporal Michael J. Crescenz VA Medical Centre in Philadelphia found that there was no reliable evidence to indicate that any part of the step approach—from dose increase after inadequate response to an antidepressant, switching the antidepressant after treatment nonresponse, to augmenting an antidepressant with bupropion or buspirone in the final phase—was effective.

The only add-on with consistent clinical benefit was lithium, which is rarely prescribed because of its potential damage to the thyroid glands and kidneys.

Independent controlled trials, that included a placebo, never showed any positive outcomes, the researchers say, and so the entire therapeutic approach to depression may be invalid.

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