Sub-Therapeutic Doses in the Treatment of Depression: The Implications of Starting Low and Going Slow

Abstract

Psychiatrists who opt to treat depression with antidepressant medication typically “start low and go slow” – initially prescribing modest doses and then gradually increasing them. General practitioners, moreover, tend to prescribe low, even sub-therapeutic, maintenance doses of antidepressants. Indeed, some patients report clinical improvements even while taking extremely low-dose medication. Controversial meta-analytic findings suggest a negligible clinical benefit of antidepressants over placebos for the treatment of mild-to-moderate depression, although both interventions improve depression ratings compared to no-treatment. Do sub-therapeutic doses of antidepressants provide a treatment prospect for healthcare professionals who wish to use placebo-like treatments for depression? In this paper, we use results from psychiatrist interviews to explore the vagaries of sub-therapeutic doses and shed light on whether they have a place in the armamentarium of the modern clinician.