The Emperor’s New Drugs: Exploding the Antidepressant Myth
by Irving Kirsch. Basic Books, 2010
Prozac, Zoloft, Paxil, Effexor, Celexa. These popular antidepressants are effective—but their function arises mainly from the placebo effect. Psychologist Irving Kirsch arrived at this conclusion a few years ago after he and his colleagues took a thorough look at all the data from experiments with antidepressants.
In The Emperor’s New Drugs, Kirsch reports that sugar pills are about as effective as antidepressants and that for many years drug companies withheld this information. Moreover, these placebos don’t have to be sugar pills; even a synthetic thyroid hormone, disguised as an antidepressant, helped to alleviate depression in subjects with no thyroid problems.
Kirsch reveals some unsavory pharmaceutical company practices. He reports that drug companies frequently manipulate scientific data—by cherry-picking positive results, withholding negative findings from publication, and “salami slicing” (publishing positive data multiple times). For instance, in the 1990s GlaxoSmithKline conducted several trials on the effectiveness of the antidepressant Paxil, which showed the drug was no more effective than a placebo. The trials also revealed some dangerous side effects, including a possible increased risk of suicide. GSK, however, decided not to release most of the negative data to the public. When this negligent behavior was later uncovered, the company was sued by the New York attorney general for engaging in “repeated and persistent fraud.” The company was forced to make all the data public.
In light of the fact that tens of millions of Americans—including many children—are taking antidepressants, it’s hard not to find Kirsch’s account disturbing. Moreover, it makes one wonder about the testing and approval processes for other medications. “For society as a whole, knowledge of what the data on antidepressants really say should be a clarion call,” Kirsch says. We can only hope that the call will be heard.
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15 Comments
Add CommentI think a large part of the problem is who is receiving these drugs. Are these people actually depressed or just sad? So many people want an instant fix to their life situations and popping a pill is so much easier than dealing with your crappy marriage. To me, this explains the placebo effect since these people weren't sick to begin with. This certainly doesn't excuse the drug companies from being underhanded and fraudulent though.
Reply | Report Abuse | Link to thisI started taking anti depressants a few years ago when I became so anxious and depressed I thought about dying everyday. I am still in my crappy marriage, but no longer feel like dying everyday. Worth it! Placebo or not.
Reply | Report Abuse | Link to thisAnd the problem is it does work for a small amount of people, this does not justify giving it to 95% of the people who don't need it. They will lose their ability to bring themselves out of a depression.
Reply | Report Abuse | Link to thisSome people have a real problem, but most don't.
Reply | Report Abuse | Link to thisThe effectiveness of antidepressants was many times called into question, last around 2003, when labels on drug packaging were introduced to warn patients of the possible risks of suicides. Ironically, the subsequent 18% increase in teen suicides in the USA can be attributed to serious cases of depression that were left untreated, as a consequence of parents taking the labels too seriously. I am hoping that parents will not interpret this article in a similar manner.
To many outsiders, depression might seem a kind of a mood swing, of which people should "snap out of " by "thinking positively" and "seeing the bright side of life". To these people, antidepressants are unnecessary, frivolous products of our times, and articles like this may seem a welcome breath of fresh air.
There is wide professional consensus however that depression is a very serious, sometimes deadly, physiological disease. There is also research and statistical data supporting that antidepressants do work.
I am in no position to assert that these statistics are unbiased and correct, or to question the results of years of serious research. It does seem to me however that encouraging people to doubt the effectiveness of medical treatment when their lives might be at stake is a very dangerous practice.
Pharmaceutical companies can have (and probably do have) many unethical practices, and these should be brought to light. Particular cases of this are however no reason to bringing into question the overall effectiveness of a type of treatment (as this article seems to suggest).
In light of the seriousness of the topic and the (life threatening) dangers of "popular beliefs" regarding depression, I would have expected Scientific American to make it clear that Irving Kirsch's interpretation of statistical data is not undisputed, and that other interpretations exist showing in contrast that antidepressants do work, and that suicide rates increase when antidepressants are withheld from patients.
I am someone with OCD who uses Cymbalta. I must say it does work and has changed my life. I find it interesting that a psychologist is putting down medical choices. I hate broad sweeps in discussions of this nature. The old saying "Never let the truth get in the way of a good story" apply here. This is the sort of article that makes me reconsider my subscription to the magazine. If I want this type of journalism I can always resort to Fox news and not have to pay a subscription fee.
Reply | Report Abuse | Link to thisNO, for sure antidepressants, and hypnotics, and anxiolitics, and anti-psychotics, and mood stabilizers are far, far away from placeboes.The issue is that sometimes it's very difficult to reach a reliable and operative diagnosis. If you look at the SCID-P, an old structured clinical interview to make DSM diagnoses, written by Robert Spitzer and Janet Williams, it contains more than 30 pages. By the way: if the author of this SciAm article is a psychologist, and those professionals do not have a right to make drug prescriptions: how can a person like that, that has no legal permit to have experience in drug therapy, make any comment about it? Psychotherapy is a totally different, longer and expensive way for mind improvement.
Reply | Report Abuse | Link to this@Roland:
Reply | Report Abuse | Link to thisExcellent comments, particularly:
"...encouraging people to doubt the effectiveness of medical treatment when their lives might be at stake is a very dangerous practice."
These drugs are more for keeping costs down, big pharma profits up than actually helping people, most of which get better using them or not.
Reply | Report Abuse | Link to thisBetter in many cases is exercise, group therapy or just talking it out. Drugs should only be the last resort.
Some drugs like Satins can cause depression as it did with me. Stopping it solved the problem.
When we treat clinical depression, using one medication, such as an antidepressant, does not help most patients. So equating the treatment of depression with the use of only one medication, in particular an antidepressant, is misleading. There are many ways to augment the effect of an antidepressant and all of these methods are commonly used. We no longer try to just get someone better, rather we aim to get someone completely better. The percentage of patients we can improve is impressive today. Even the percentage we can return to normal or close to normal functioning is remarkable. My opinion is based on my entire clinical psychiatric practice which spans 27 years and close to 12,000 patients.
Reply | Report Abuse | Link to thisAntidepressent, in what so ever nature, becomes copulsive once taken. Any psychiatric or psychological problems of varying intensity should be treated by methods other than involving medication. In many of the cases what I have noticed among the psychiatrics is that they tend to recomend drugs wtih out having completed enough investigation nor do they seek a second and third openion. It is worth analysing and evaluating the present if not popular psychiatric practices.
Reply | Report Abuse | Link to thisOk ...so take 2 Snickers Bars , and call me in the morning !!
Reply | Report Abuse | Link to this"[B]ased on my [exntensive] practice" sounds anecdotal to me. This article is a book review, not an absolute endorsement. Many books have been published about the effectiveness of psychopharmacology, some supported more extensively by data than others. What troubles me is the lack of data on "enhancements" and on long-term effects.
Reply | Report Abuse | Link to thisCaveat emptor. If you go to the doctor expecting a prescription for medication, you will probably get one, regardless of the type of doctor. Is this a problem with patient expectations or with medical ethics or with the power of Big Pharma? Or, like treatment for depression and the causes of depression itself, a combination of factors that may never be teased out.
Am wondering if the author is a Scientologist....
Reply | Report Abuse | Link to thisI am a prescribing psychologist, who just finished reading Kirsch's book, after having read several about the placebo effect. I was impressed with the book, which I thought from the the title would be a polemic. It's actually a tightly reasoned book. Here's the gist: nearly every double-blind study shows that about 50% of patients improve with the an antidepressant and about 40% with the placebo. This means that if any particular person responds, there is an 80% chance that it was not because of the drug. Studies that include a no-treatment group show that patients receiving nothing recover less frequently than those on placebo.
Reply | Report Abuse | Link to thisFrom the perspective of the patient taking a pill, the experience of recovery is the same and nearly always attributed to the drug, whether true or false. It is really not so far fetched then, if it turned out, as Kirsch concludes, that all or nearly all of the effect is placebo. His main argument rests on the not unreasonable assumption that both doctors and patients in double-blind studies are able to tell whether the pill is medication or placebo, based on side-effects. When "active placebos" (i.e., medications that are not antidepressants, but have similar side-effects) are used, the advantage of medication over placebo virtually disappears. Intriguing and disturbing.
Anyone or the parents of anyone prescribed these antidepressants should be required to sign a waiver that they have been informed by their doctor of the harmful side effects including death these drugs can cause and that once they have signed the waiver cannot sue pharmaceutical companies, psychiatrists or healthcare providers for damages from an adverse outcome or wrongful death. The waiver would include a sign off list of complete data for and against antidepressants and would include a summary report of adverse side effects reported to the FDA and a listing of antidepressant liability lawsuits, findings and settlement terms that the liability form signer was provided and actually read.
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