It’s been more than a decade since scientists first published the startling (and, let’s face it, rather depressing) finding that antidepressant medications are no more effective than a placebo at lifting depression in most people.
In the meantime, sales of antidepressants in the United States have doubled, from 13.3 million in 1996 to 27 million in 2005. In 2008, American spent $9.6 billion on these drugs.
Are antidepressants “a triumph of marketing over science”? Maybe, suggests science writer Sharon Begley in the cover article of the Feb. 8 issue of Newsweek. In the article, she details why, despite the strong scientific evidence that “the lion’s share of the drugs’ effect comes from the fact that patients expect to be helped by them, and not from any direct chemical action on the brain,” consumers and physicians alike continue to resist the idea that antidepressants are “basically expensive Tic Tacs” for everybody except those with very severe depression.
I’ve emphasized that last phrase because I, like Begley, worry that people for whom these drugs are working will suddenly stop taking them. As Begley points out, tossing out the medications “can cause serious withdrawal symptoms, including twitches, tremors, blurred vision, and nausea — as well as depression and anxiety.”
Still, it’s clear from the growing pile of research, including a study published in January in the Journal of the American Medical Association, that for people with mild to moderate depression (that’s 87 percent of people being treated for the illness), the placebo effect explains most of the drugs’ benefits.
As one of the co-authors of the latest study, a meta-analysis of six previously published placebo-controlled studies, told Begley: “Most people don’t need an active drug. For a lot of folks, you’re going to do as well on a sugar pill or on conversations with your physicians as you will on medication. It doesn’t matter what you do; it’s just the fact that you’re doing something.”
Indeed, psychotherapy has been shown to be more effective — and to have significantly lower relapse rates — than either pills or placebos for treating mild to moderate depression, Begley points out. “But there’s the little matter of reality,” she adds. “In the U.S., most patients with depression are treated by primary-care doctors, not psychiatrists. The latter are in short supply, especially outside cities and especially for children and adolescents. Some insurance plans discourage such care, and some psychiatrists do not accept insurance.”
For these reasons, many experts believe that the current “don’t ask, don’t tell” policy about antidepressants should continue. Even a placebo effect is better than no effect for people in emotional pain, they argue.
But a growing number of scientists believe it’s time to end this charade. One of those is Irving Kirsch, the University of Connecticut professor of psychology who co-authored the 1998 landmark study that first raised serious questions about the effectiveness of antidepressants, and who, despite some nasty attempts by antidepressant advocates to marginalize him professionally, has continued his research on this topic. (His book, “The Emperor’s New Drugs,” was published late last year.) Writes Begley:
Maybe it is time to pull back the curtain and see the wizard for what he is.… If placebos can make people better, then depression can be treated without drugs that come with serious side effects, not to mention costs. Wider recognition that antidepressants are a pharmaceutical version of the emperor’s new clothes, [says Kirsch], might spur patients to try other treatments. “Isn’t it more important to know the truth?” he asks. Based on the impact of his work so far, it’s hard to avoid answering, “Not to many people.”