Do Antidepressants Improve Quality of Life?

Depression is one of the most common mental disorders in the United States. It’s estimated that 21 million adults had at least one major depressive episode in 2020, and about two-thirds of those people received treatment, according to the National Institute of Mental Health.

But do people who are depressed and take an antidepressant have improvements in their health-related quality of life compared with those who don’t take medications? Not according to a new national study of U.S. adults: Though the people taking medications for their depression had some improvements in health-related quality of life, they weren’t significantly greater than those reported by individuals with depression who didn’t take the drugs, according to a new analysis published April 20 in PLoS One.

Depression Has Worsened During the Pandemic

Symptoms of depression can include a depressed mood, a loss of interest or pleasure in daily activities, and symptoms that include problems with sleep, eating, energy, concentration, or self-worth.

Before the pandemic, about 1 in 12 U.S. adults reported depressive symptoms each year. According to research published in October 2021 in the journal Lancet Regional Health Americas, that number has now tripled; nearly 1 in 3 U.S. adults — 32.8 percent — experienced elevated depressive symptoms in 2021.

Findings Suggest Antidepressants Did Little to Improve Health-Related Quality of Life

To examine the impact of antidepressants on quality of life measures in people with depression, the researchers used data from the 2005–2015 United States Medical Expenditures Panel Survey (MEPS), a large longitudinal study that tracks use of health services.

During the study period, an average of 17.5 million adult patients were diagnosed with depression, and 57.6 percent received treatment with antidepressant medications. Each participant took a quality of life survey called the SF-12, a self-reported survey that was used to measure health-related quality of life at the start of the study period and at the end of the two-year follow-up. The mental health component of the SF-12 includes questions about energy, mood, and emotional state, and if emotional problems have interfered with the person’s ability to do normal activities.

Taking antidepressants was associated with some improvement on the mental component of SF-12, but when this positive change was compared with the change in the group of people who didn’t take antidepressants, the improvement wasn’t statistically significant, according to the researchers.

The authors concluded: “The real-world effect of using antidepressant medications does not continue to improve patients’ health-related quality of life over time,” since the change was about the same as in the group that didn’t take any drugs.

Experts Have Found Major Flaws in the Study Design and Conclusions

It would be a mistake to conclude that antidepressants don’t improve the quality of life for people with depression on the basis of this study, says Paul Nestadt, MD, an assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine in Baltimore.

For starters, the tool used to assess quality of life was “rough and inelegant," he says. “Even though there was a 25 percent greater improvement in the mental component of the scale among patients taking antidepressants compared with the improvement without them (1.2 points vs 0.9 points), the effect as measured was too small to be statistically significant,” says Dr. Nestadt. By these standards, it would be difficult for any improvements to register statistical significance, he says.

Although the health-related quality of life scale is useful for some studies as a way to gauge certain aspects of public health, it’s not an appropriate tool to access the efficacy of antidepressants, says Bradley Gaynes, MD, MPH, the division head of global mental health at the UNC School of Medicine in Chapel Hill, North Carolina. “Health-related quality of life is a hard thing to demonstrate change in. I would put more weight on these findings if the authors had used a tool that measured depression itself,” he says.

Additionally, the authors do not account for those who used other, alternative treatments for depression, such as psychotherapy versus nothing at all, says Nestadt. “There is so much unmeasured in these groups, including biases, such as who can afford different treatments, have access to them, or be willing to pursue them, that very few true conclusions can be drawn from this analysis of a large but superficial data set,” he says.

Treating Depression Is Effective and Important

These findings don’t fit with what Nestadt sees in his clinic. “In my experience, treating depression is quite effective. We have many useful treatment interventions, including medication and psychotherapy among others, and I have found that when these are utilized to treat a depressive disorder, the patient’s quality of life improves dramatically,” he says.

Dr. Gaynes too says the findings and the authors’ conclusions don’t match his clinical experience. “When we can identify clearly diagnosed depressive disorder and provide an adequately dosed treatment — whether that’s a medication, psychotherapy, or another evidence-based therapy, it makes their depression less severe and they get better more quickly,” he says.

People who are depressed should seek treatment from a professional, and people with depression who are taking an antidepressant should continue to take their medication as directed by their healthcare provider, says Gaynes.

“Depression is a treatable illness, and yet one symptom of the illness is a perception of hopelessness,” says Nestadt. That can mean that even though most studies show tremendous benefit from treatment, some individuals may feel that nothing will work for them, he adds.

“That is dangerous and one reason that people do not get care. Overstated conclusions from papers like this one may contribute to that hopelessness and run contrary to what we know can save lives,” he says.