Antidepressants are proven to be effective (Cipriani et al., 2018; Tomlin, 2018), but they can also pose challenges. While some individuals experience significant improvements in their mood, others may not notice any difference or even feel worse. Additionally, the range of side effects associated with antidepressants can be troubling, and stopping them can lead to withdrawal symptoms (Bowers, 2024; Read et al., 2023). Therefore, the debate continues regarding the overall worth of antidepressants, considering both the benefits and drawbacks.
Traditional metrics like effect size and Minimum Important Change (MIC) do not fully capture the patient’s perspective on the importance of benefits and do not consider the comparison of burdens and benefits of different treatment options. A recent study by Sahker and colleagues (2024) aimed to estimate the Smallest Worthwhile Difference (SWD) of antidepressants, which refers to the smallest beneficial effect of treatment that justifies the associated costs, risks, and inconveniences.
The study employed an online cross-sectional survey with participants from the general population experiencing symptoms of depression but not currently undergoing treatment. The results revealed that the SWD for most participants was higher than the estimated response rate difference, indicating a preference for more significant benefits from antidepressants. The study also found that the preference for antidepressants or psychotherapy was a key factor influencing the SWD.
In conclusion, the study highlights the importance of considering patients’ perspectives on treatment benefits and burdens when deciding on antidepressant therapy. The findings suggest the need for further research to determine the SWD for different treatments, disorders, and diseases. Additionally, the study encourages healthcare providers to engage in more meaningful discussions with patients about the potential benefits and burdens of antidepressant treatment.
This novel approach to measuring the acceptable level of treatment benefits in relation to burdens could inform clinical practice and improve decision-making processes not only for antidepressants but for other treatments as well. Furthermore, exploring the SWD in different populations, such as primary care settings, could provide valuable insights into the individual variation in treatment preferences. Ultimately, understanding the SWD can lead to more patient-centered care and improve the overall quality of treatment decision-making.
