Millions of Americans are affected by major depressive disorder within a given year. According to the Centers for Disease Control and Prevention, in 2003-2004 antidepressants were the most widely prescribed drugs for adults ages 18 to 64 (http://bit.ly/d1ZDFt). Over the past five decades, many studies have shown antidepressants to be superior to placebo in reducing symptoms of depression, but a recent review of the literature calls their usefulness in combating less severe depression into question.

Researchers analyzed data from six randomized trials in which 718 adult patients diagnosed with depression were given either antidepressants or placebo. The data revealed that the effects of antidepressant medication increased substantially as the severity of depression symptoms increased, and were the greatest when symptoms were very severe-but were minimal or nonexistent when symptoms were mild or moderate.

The study's results have created quite a stir, according to Candice Knight, president of the Society of Psychiatric Advanced Practice Nurses of the New Jersey State Nurses Association. "It's much easier to give medications than find out the cause," said Knight, who's also a licensed psychologist. "We need to take into consideration better assessment tools and look at the underlying psychology as we treat mild-to-moderate depression."

Sandra Seidel, who's an assistant professor of nursing at Vanderbilt University Medical Center in Nashville, Tennessee, and works with some of the study's authors, emphasized that deciding how to treat should always be a patient-driven process. "Even though the drugs didn't differ from placebo in patients with mild-to-moderate depression, that doesn't mean no one with this degree of depression responds to the drug," she said. "And we don't know whether giving the drug keeps the patient from getting worse."

Kristen Georgi