… compared with placebo, the new-generation antidepressants do not produce clinically significant improvements in depression in patients who initially have moderate or even very severe depression, but show significant effects only in the most severely depressed patients. The findings also show that the effect for these patients seems to be due to decreased responsiveness to placebo, rather than increased responsiveness to medication. Given these results, the researchers conclude that there is little reason to prescribe new-generation antidepressant medications to any but the most severely depressed patients unless alternative treatments have been ineffective.Kirsch, Deacon, Huedo-Medina, Scoboria, Moore and Johnson
Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration
I’ve just finished reading the actual study (link above). It’s a statistical analysis of the available data, not a psychiatric / medical study in itself, so it was tough going and rather dull stuff for someone like me with no formal training in statistics. All the same, if this study is confirmed (and it’s important to note that it has only just been opened up to the peer-review process, so we shouldn’t leap to any conclusions until this has been done) then it’s a damning indictment not only of the pharmaceutical companies (who, after all, we kind of expect this kind of behaviour from anyway) but more importantly of the regulatory bodies all over the world who have approved this medication.
In the interests of full disclosure, I should point out that the findings come as something of a surprise to me. Some years ago I was diagnosed with clinical depression (on the severe side, but not within the “most severe” category… I did not require hospitalisation, though it was considered at one stage) and prescribed extremely high doses of one of the SSRIs investigated by the Hull analysis. I’m no longer taking them — I’m very glad to say, as I wasn’t a fan of the side-effects — but I do attribute my recovery in part to the medication. Needless to say, I’m rather intrigued by the possibility that I’d have gotten roughly the same benefit from a placebo.
Indeed, if anything, this seems to be another justification for my current belief that psychoanalytic psychotherapy (incorporating, though not restricted to, some of the techniques of Cognitive Behavioural Therapy) is the best treatment for depression. It probably goes without saying, that particular belief is one of the primary reasons I’m studying what I’m studying (mind you, that’s a far longer article).
Because of the enthusiastic approval of anti-depressants by official regulators, doctors see it as a simple and efficient way of treating an increasingly common illness. Unfortunately, if — as it appears — the bloody things don’t actually work, then it means we’re flushing an awful lot of public money down the drain (or rather, we’re meekly handing it over to large corporations) which has an actively damaging effect on public health, as we’re underfunding other therapies which do have a clinically significant effect above and beyond that produced by a placebo.
As I say, we half-expect large corporations to fudge the figures in search of profit, but the regulatory bodies are supposed to be on our side. We employ them to root-out these kinds of false claims, but if this study is confirmed, it would appear that the FDA (and the others who followed suit) are guilty either of dangerous incompetence, or of deliberately putting corporate profits before the mental health of the public.
UPDATE 16:35 I was chatting with a friend today. His girlfriend was on the same antidepressants as I was prescribed (Venlafaxine) and like me, she found them helpful but is glad to be off them. He said, mischievously but rather perceptively, “aren’t you lucky you were taking them while they still worked?”